| NPI | 1619928587 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: OR 3386ATI) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: ID ODP-100098) |
| Enumeration Date | 2006-05-15 |
| Last Update Date | 2017-04-26 |