| NPI | 1770580755 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: SC 539) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: SC SC0539) |
| Enumeration Date | 2005-07-05 |
| Last Update Date | 2018-10-29 |