| NPI | 1427208024 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: PR 733) |
| Additional Taxonomies | 156FX1800X Technician/Technologist Optician (Licence: PR 598) |
| Enumeration Date | 2008-09-19 |
| Last Update Date | 2019-08-15 |