| NPI | 1588678429 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: MT 627) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: CO 2180) |
| Enumeration Date | 2006-07-28 |
| Last Update Date | 2014-10-02 |