| NPI | 1952412496 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: AZ 0207) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: AZ az0207) |
| Enumeration Date | 2006-08-31 |
| Last Update Date | 2010-09-07 |