| NPI | 1093711640 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152WC0802X Optometrist Corneal and Contact Management (Licence: VA 0618000156) |
| Additional Taxonomies | 152WL0500X Optometrist Low Vision Rehabilitation (Licence: VA 0618000156) |
| Enumeration Date | 2005-06-27 |
| Last Update Date | 2007-07-08 |