| NPI | 1972645331 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: VA 06180000229) |
| Additional Taxonomies | 156F00000X Technician/Technologist (Licence: VA 06180000229) |
| Enumeration Date | 2007-02-13 |
| Last Update Date | 2008-06-13 |