| NPI | 1871522235 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: ID ODP-100237) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: CO 868) |
| Enumeration Date | 2006-06-30 |
| Last Update Date | 2012-07-13 |