| NPI | 1922009836 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: OR 1942AT ACTIVE) |
| Additional Taxonomies | 237700000X Hearing Instrument Specialist (Licence: OR HAS-P-470158) |
| Enumeration Date | 2005-08-02 |
| Last Update Date | 2012-01-11 |