| NPI | 1639148513 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: OR 2030AT) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: CA 9089) |
| 152W00000X Optometrist (Licence: HI 277) | |
| Enumeration Date | 2006-03-14 |
| Last Update Date | 2007-07-09 |