| NPI | 1932155827 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NE 915) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: IA 01937) |
| 152W00000X Optometrist (Licence: MN 2081) | |
| Enumeration Date | 2006-05-25 |
| Last Update Date | 2010-02-10 |