| NPI | 1962423962 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: AL T-234-TA-B13) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: TX 03479TG) |
| Enumeration Date | 2006-07-22 |
| Last Update Date | 2017-10-30 |