| NPI | 1396715512 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | Yes | 
| Primary Taxonomy | 152W00000X Optometrist (Licence: DE I30001138) | 
| Additional Taxonomies | 152WC0802X Optometrist, Corneal and Contact Management (Licence: DE I3-0001138) | 
| Enumeration Date | 2006-01-23 | 
| Last Update Date | 2007-11-15 |