| NPI | 1487817896 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152WC0802X Optometrist, Corneal and Contact Management (Licence: PA OEG-002146) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: SC 1523) |
| Enumeration Date | 2008-07-07 |
| Last Update Date | 2016-01-28 |