| NPI | 1417987512 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152WC0802X Optometrist, Corneal and Contact Management (Licence: SC SC972) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: SC SC972) |
| Enumeration Date | 2006-07-04 |
| Last Update Date | 2009-03-25 |