| NPI | 1740257278 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: MN 1666) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: GA OPT001629) |
| 152W00000X Optometrist (Licence: IL 046 006817) | |
| Enumeration Date | 2006-03-03 |
| Last Update Date | 2007-07-08 |