| NPI | 1841382074 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: TN OD-T2529) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NE 1141) |
| Enumeration Date | 2006-09-28 |
| Last Update Date | 2011-06-11 |