| NPI | 1740324979 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: CO 2186) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: MT 678) |
| Enumeration Date | 2007-02-19 |
| Last Update Date | 2012-01-18 |