| NPI | 1467523167 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: TN OD2307) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: TN OD0000002307) |
| Enumeration Date | 2006-11-13 |
| Last Update Date | 2011-08-23 |