| NPI | 1497753040 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: TX J6050) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: TX J6050) |
| Enumeration Date | 2005-07-08 |
| Last Update Date | 2020-09-08 |