| NPI | 1952488314 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: TN ODT1679) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: VA 2046) |
| Enumeration Date | 2006-11-01 |
| Last Update Date | 2007-07-08 |