| NPI | 1083874036 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: SC 1499) |
| Additional Taxonomies | 152WC0802X Optometrist, Corneal and Contact Management (Licence: SC 2041) |
| Enumeration Date | 2008-06-12 |
| Last Update Date | 2014-01-13 |