| NPI | 1033161245 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NE 1123) |
| Additional Taxonomies | 152WC0802X Optometrist Corneal and Contact Management (Licence: NE 1123) |
| 152WS0006X Optometrist Sports Vision (Licence: NE 1123) | |
| Enumeration Date | 2006-05-16 |
| Last Update Date | 2007-07-08 |