| 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 |