| NPI | 1164685947 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: GA OPT002629) |
| Additional Taxonomies | 152WP0200X Optometrist, Pediatrics (Licence: GA OPT002629) |
| 152WC0802X Optometrist, Corneal and Contact Management (Licence: GA OPT002629) | |
| Enumeration Date | 2008-07-02 |
| Last Update Date | 2016-11-17 |