| NPI | 1588812390 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: AK OPTT343) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: OR 3273ATI) |
| Enumeration Date | 2008-09-04 |
| Last Update Date | 2018-10-12 |