| NPI | 1417933078 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: SC SC755) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NC NC1095) |
| Enumeration Date | 2005-12-15 |
| Last Update Date | 2008-09-09 |