| NPI | 1467557751 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: TN 945) |
| Additional Taxonomies | 152WC0802X Optometrist, Corneal and Contact Management (Licence: TN ODT 945) |
| Enumeration Date | 2006-09-13 |
| Last Update Date | 2018-08-13 |