| NPI | 1417028952 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: UT 109507-9934) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: WA 1040) |
| 152W00000X Optometrist (Licence: UT 109507-8908) | |
| Enumeration Date | 2006-11-13 |
| Last Update Date | 2007-07-08 |