| NPI | 1093997843 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152WC0802X Optometrist Corneal and Contact Management (Licence: MN 3110) |
| Additional Taxonomies | 152WS0006X Optometrist Sports Vision (Licence: MN 3110) |
| Enumeration Date | 2007-12-04 |
| Last Update Date | 2008-01-16 |