| NPI | 1174842363 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: NC 2015-00262) |
| Additional Taxonomies | 152WC0802X Optometrist, Corneal and Contact Management (Licence: PA MD452040) |
| Enumeration Date | 2010-05-27 |
| Last Update Date | 2020-10-26 |