| NPI | 1003244708 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: MA 5001) |
| Additional Taxonomies | 152WC0802X Optometrist, Corneal and Contact Management (Licence: MA 5001) |
| 152W00000X Optometrist (Licence: OH 6261) | |
| Enumeration Date | 2013-10-16 |
| Last Update Date | 2016-08-11 |