| NPI | 1710148028 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: AL S-B98-TA-783) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: AL T-194-TA-783) |
| Enumeration Date | 2008-06-19 |
| Last Update Date | 2009-09-14 |