| NPI | 1598751778 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: OK 2299) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: MO T03481) |
| Enumeration Date | 2005-09-23 |
| Last Update Date | 2017-12-27 |