| NPI | 1275603672 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152WC0802X Optometrist Corneal and Contact Management |
| Additional Taxonomies | 152WP0200X Optometrist Pediatrics |
| Enumeration Date | 2006-11-09 |
| Last Update Date | 2007-11-20 |