| NPI | 1013970631 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152WL0500X Optometrist, Low Vision Rehabilitation (Licence: PR 458099) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: PR 458099) |
| 152WC0802X Optometrist, Corneal and Contact Management (Licence: PR 458099) | |
| Enumeration Date | 2006-04-07 |
| Last Update Date | 2025-09-11 |