| NPI | 1669779195 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: SD 750) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: CO 0003034) |
| Enumeration Date | 2011-02-18 |
| Last Update Date | 2019-03-25 |