| NPI | 1669518874 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: MO T03327) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: KS 1422-3) |
| Enumeration Date | 2007-01-29 |
| Last Update Date | 2008-01-31 |