| NPI | 1932125424 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NC 1695) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: VA 0618001193) |
| Enumeration Date | 2006-07-15 |
| Last Update Date | 2012-12-04 |