| NPI | 1497837751 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: IA 01683) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NE 1017) |
| Enumeration Date | 2006-10-19 |
| Last Update Date | 2007-07-08 |