| NPI | 1659680734 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: AZ 2000) |
| Additional Taxonomies | 152WL0500X Optometrist, Low Vision Rehabilitation (Licence: AZ 2000) |
| Enumeration Date | 2010-10-06 |
| Last Update Date | 2015-04-28 |