| NPI | 1871908236 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: WI 3353-35) |
| Additional Taxonomies | 171000000X Military Health Care Provider (Licence: WI 3353-35) |
| Enumeration Date | 2014-06-24 |
| Last Update Date | 2017-10-24 |