| NPI | 1407881105 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: MO TO2926) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: KS 1349) |
| Enumeration Date | 2006-07-11 |
| Last Update Date | 2020-01-09 |