| NPI | 1073532693 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152WC0802X Optometrist, Corneal and Contact Management (Licence: MS 468) |
| Additional Taxonomies | 152WC0802X Optometrist, Corneal and Contact Management (Licence: TN 673) |
| 152W00000X Optometrist (Licence: TN 673) | |
| Enumeration Date | 2006-07-18 |
| Last Update Date | 2019-01-31 |