| NPI | 1598760894 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NC 1392) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: SC 1165) |
| Enumeration Date | 2005-06-15 |
| Last Update Date | 2010-01-29 |