| NPI | 1235195827 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: NC 24730) |
| Additional Taxonomies | 152WC0802X Optometrist, Corneal and Contact Management (Licence: NC 24730) |
| Enumeration Date | 2006-04-24 |
| Last Update Date | 2010-05-25 |