| NPI | 1043358823 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: FL 1155) |
| Additional Taxonomies | 152WC0802X Optometrist Corneal and Contact Management (Licence: FL 1155) |
| Enumeration Date | 2007-02-02 |
| Last Update Date | 2011-10-06 |