| NPI | 1841355245 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NV 751) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: UT 278987-9934) |
| 152W00000X Optometrist (Licence: ID 0DP-1068) | |
| Enumeration Date | 2006-12-26 |
| Last Update Date | 2014-01-15 |