| NPI | 1245248590 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: GA 031339) |
| Additional Taxonomies | 152WC0802X Optometrist, Corneal and Contact Management (Licence: GA 031339) |
| Enumeration Date | 2006-08-03 |
| Last Update Date | 2022-07-21 |