| NPI | 1609072586 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: KS 1768) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: GA OPT002382) |
| Enumeration Date | 2007-06-26 |
| Last Update Date | 2012-09-28 |