| NPI | 1679592679 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: TN 2906) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: OK 1076) |
| Enumeration Date | 2006-07-19 |
| Last Update Date | 2014-03-26 |