| NPI | 1184794745 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: CO 2025) |
| Additional Taxonomies | 152WC0802X Optometrist Corneal and Contact Management (Licence: WY 209T) |
| 152WC0802X Optometrist Corneal and Contact Management (Licence: CO 2025) | |
| Enumeration Date | 2006-11-09 |
| Last Update Date | 2022-11-02 |