| NPI | 1104982701 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: TN 859) |
| Additional Taxonomies | 152WC0802X Optometrist, Corneal and Contact Management (Licence: TN ODT859) |
| Enumeration Date | 2006-12-28 |
| Last Update Date | 2021-12-21 |