| NPI | 1346813904 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: OR ATI4619) |
| Additional Taxonomies | 152WC0802X Optometrist, Corneal and Contact Management (Licence: OR ATI4619) |
| Enumeration Date | 2021-07-21 |
| Last Update Date | 2024-01-11 |