| NPI | 1538113683 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: TX 9173T) |
| Additional Taxonomies | 152WC0802X Optometrist Corneal and Contact Management (Licence: MO T02785) |
| Enumeration Date | 2006-05-22 |
| Last Update Date | 2017-08-31 |