| NPI | 1437250073 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: MN LF1587000) |
| Additional Taxonomies | 152WC0802X Optometrist, Corneal and Contact Management (Licence: MN LD1587000) |
| Enumeration Date | 2006-09-26 |
| Last Update Date | 2008-12-10 |