| NPI | 1023159324 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: WI 1707) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: CA 9123) |
| 152WC0802X Optometrist, Corneal and Contact Management (Licence: WI 1707) | |
| Enumeration Date | 2007-02-09 |
| Last Update Date | 2007-09-11 |