| NPI | 1891772489 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: KS 1699) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: MO 2000160785) |
| 152W00000X Optometrist (Licence: AR 2544) | |
| Enumeration Date | 2005-12-27 |
| Last Update Date | 2012-05-09 |