| NPI | 1538138227 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: AZ 1893) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: CO 2481) |
| Enumeration Date | 2006-03-15 |
| Last Update Date | 2015-08-04 |