| NPI | 1770896987 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: ID ODP-100211) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NV 679) |
| Enumeration Date | 2010-07-16 |
| Last Update Date | 2012-10-15 |