| NPI | 1104810795 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152WC0802X Optometrist, Corneal and Contact Management (Licence: NE 815) |
| Additional Taxonomies | 152WP0200X Optometrist, Pediatrics (Licence: NE 815) |
| Enumeration Date | 2005-09-09 |
| Last Update Date | 2009-12-03 |