| NPI | 1255327011 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152WC0802X Optometrist, Corneal and Contact Management (Licence: NV 0256) |
| Additional Taxonomies | 152WP0200X Optometrist, Pediatrics (Licence: NV 0256) |
| 152WX0102X Optometrist, Occupational Vision (Licence: NV 0256) | |
| Enumeration Date | 2005-09-26 |
| Last Update Date | 2012-03-30 |