| NPI | 1851731459 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NE 1396) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: IA 002602) |
| Enumeration Date | 2013-06-27 |
| Last Update Date | 2014-12-03 |