| NPI | 1427140417 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: UT 6347896-9934) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: MT 692 OPT) |
| Enumeration Date | 2006-09-28 |
| Last Update Date | 2007-11-09 |