| NPI | 1548281306 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NC 1934) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: SC SC1274) |
| Enumeration Date | 2006-07-21 |
| Last Update Date | 2008-12-12 |