| NPI | 1881659001 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: IA 02177) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: MN 3132) |
| Enumeration Date | 2006-04-19 |
| Last Update Date | 2015-04-24 |