| NPI | 1780768333 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: WI WI1750) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: WI 1750) |
| Enumeration Date | 2006-10-24 |
| Last Update Date | 2009-11-05 |