| NPI | 1982753281 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: OK 2695) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: LA 1409539T) |
| Enumeration Date | 2007-01-09 |
| Last Update Date | 2012-05-08 |