| NPI | 1679700371 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NC 2159) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: VA 0618001852) |
| Enumeration Date | 2009-06-19 |
| Last Update Date | 2012-08-29 |