| NPI | 1740582931 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: SC 1617) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: GA 2480) |
| Enumeration Date | 2010-11-22 |
| Last Update Date | 2015-07-27 |