| NPI | 1801870118 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NC 2004) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: VA 0618001487) |
| 152W00000X Optometrist (Licence: TN 2593) | |
| Enumeration Date | 2005-11-30 |
| Last Update Date | 2012-04-25 |