| NPI | 1568454155 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: AZ AZ0810) |
| Additional Taxonomies | 152WC0802X Optometrist, Corneal and Contact Management (Licence: AZ AZ0810) |
| Enumeration Date | 2005-08-18 |
| Last Update Date | 2021-01-20 |