| NPI | 1417529793 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: IA 113176) |
| Additional Taxonomies | 152WC0802X Optometrist, Corneal and Contact Management (Licence: OH 006998) |
| Enumeration Date | 2021-07-15 |
| Last Update Date | 2022-08-03 |