| NPI | 1487735767 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: MD 0579) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: DC DC0323) |
| Enumeration Date | 2006-10-17 |
| Last Update Date | 2011-01-18 |