| NPI | 1730168071 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: AZ 1475) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: UT 5350538-9934) |
| Enumeration Date | 2006-01-13 |
| Last Update Date | 2016-07-27 |