| NPI | 1518941269 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152WC0802X Optometrist, Corneal and Contact Management (Licence: MD TA732) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: MD TA732) |
| Enumeration Date | 2005-12-05 |
| Last Update Date | 2012-05-16 |