| NPI | 1942386958 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: WV 1009-OD) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: AK 203) |
| Enumeration Date | 2006-10-31 |
| Last Update Date | 2013-10-08 |