| NPI | 1245321231 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152WC0802X Optometrist, Corneal and Contact Management (Licence: AL s-646-TA-124) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: GA OPT001147) |
| Enumeration Date | 2006-09-27 |
| Last Update Date | 2010-09-30 |