| NPI | 1528065455 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NE 1247) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: FL 3958) |
| 152W00000X Optometrist (Licence: IA 02336) | |
| Enumeration Date | 2005-07-07 |
| Last Update Date | 2007-07-08 |