| NPI | 1538240973 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: SC 831) |
| Additional Taxonomies | 152WS0006X Optometrist, Sports Vision (Licence: LA 964251T) |
| Enumeration Date | 2006-10-18 |
| Last Update Date | 2015-11-17 |