| NPI | 1063599959 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152WC0802X Optometrist Corneal and Contact Management (Licence: GA GA001105) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: GA OPT001105) |
| Enumeration Date | 2006-11-01 |
| Last Update Date | 2012-02-02 |