| NPI | 1972522829 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: DE 13-0001239) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: DE 130001239) |
| Enumeration Date | 2006-07-19 |
| Last Update Date | 2015-06-08 |