| NPI | 1912919598 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NE 1229) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: IA 02319) |
| Enumeration Date | 2006-08-12 |
| Last Update Date | 2007-07-08 |