| NPI | 1598028201 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: AZ 1897) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: UT 8345018-9934) |
| Enumeration Date | 2012-06-18 |
| Last Update Date | 2013-06-17 |