| NPI | 1922064633 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: MN 2934) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: OR 2897T) |
| 152W00000X Optometrist (Licence: WA 3807) | |
| Enumeration Date | 2006-04-21 |
| Last Update Date | 2007-07-12 |