| NPI | 1982655015 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NH 0751) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: ID ODP-100056) |
| 152W00000X Optometrist (Licence: MA 4324) | |
| Enumeration Date | 2006-05-13 |
| Last Update Date | 2007-07-08 |