| NPI | 1689795304 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: AK 243) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: OR 3144ATI) |
| Enumeration Date | 2007-04-02 |
| Last Update Date | 2007-07-08 |