| NPI | 1447239736 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152WC0802X Optometrist, Corneal and Contact Management (Licence: CO CO1342) |
| Additional Taxonomies | 152WX0102X Optometrist, Occupational Vision (Licence: CO co1342) |
| Enumeration Date | 2006-01-13 |
| Last Update Date | 2011-01-12 |