| NPI | 1134299704 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152WC0802X Optometrist, Corneal and Contact Management (Licence: OH 3303 T964) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: OH OH3303) |
| Enumeration Date | 2006-11-09 |
| Last Update Date | 2015-10-08 |