| NPI | 1063586741 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: HI OD-607) |
| Additional Taxonomies | 152WC0802X Optometrist, Corneal and Contact Management (Licence: HI 607) |
| Enumeration Date | 2006-11-17 |
| Last Update Date | 2020-01-14 |