| NPI | 1891878559 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: TX 3203-TG) |
| Additional Taxonomies | 156FX1800X Technician/Technologist, Optician (Licence: TX 3203TG) |
| Enumeration Date | 2006-10-23 |
| Last Update Date | 2011-11-08 |