| NPI | 1457344186 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: GA 001753) |
| Additional Taxonomies | 152WC0802X Optometrist Corneal and Contact Management (Licence: GA 001753) |
| Enumeration Date | 2005-08-29 |
| Last Update Date | 2008-07-28 |