| NPI | 1366425605 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: TN TN635) |
| Additional Taxonomies | 152WC0802X Optometrist Corneal and Contact Management (Licence: TN TN635) |
| 152WX0102X Optometrist Occupational Vision (Licence: TN TN635) | |
| Enumeration Date | 2005-11-21 |
| Last Update Date | 2012-12-26 |