| NPI | 1093878001 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: SC 537) |
| Additional Taxonomies | 152WC0802X Optometrist, Corneal and Contact Management (Licence: SC 537) |
| 152WS0006X Optometrist, Sports Vision (Licence: SC 537) | |
| Enumeration Date | 2006-12-19 |
| Last Update Date | 2007-07-09 |