| NPI | 1497856504 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: ND 669) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: OR 3191T) |
| Enumeration Date | 2006-09-25 |
| Last Update Date | 2014-07-09 |