| NPI | 1548278112 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152WP0200X Optometrist, Pediatrics (Licence: OK OK1093) |
| Additional Taxonomies | 152WC0802X Optometrist, Corneal and Contact Management (Licence: OK 1093) |
| 152WX0102X Optometrist, Occupational Vision (Licence: OK 1093) | |
| Enumeration Date | 2006-08-03 |
| Last Update Date | 2011-10-26 |