| NPI | 1275591711 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152WC0802X Optometrist, Corneal and Contact Management (Licence: ID ODP-959) |
| Additional Taxonomies | 152WC0802X Optometrist, Corneal and Contact Management (Licence: UT 351670-9934) |
| 152WC0802X Optometrist, Corneal and Contact Management (Licence: AZ 1853) | |
| 152W00000X Optometrist (Licence: CA 14349) | |
| Enumeration Date | 2006-05-03 |
| Last Update Date | 2016-02-01 |