| NPI | 1598889891 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NM OP2281) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: AZ 01246) |
| Enumeration Date | 2007-03-19 |
| Last Update Date | 2011-03-01 |