| NPI | 1487653218 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 174400000X Specialist (Licence: UT 1713361205) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: UT 171336-1205) |
| Enumeration Date | 2005-07-14 |
| Last Update Date | 2012-03-01 |