| NPI | 1457317976 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: NC 2001-00337) |
| Additional Taxonomies | 152WC0802X Optometrist, Corneal and Contact Management (Licence: NC 200100337) |
| Enumeration Date | 2006-04-24 |
| Last Update Date | 2015-01-23 |