| NPI | 1578509873 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NE 1202) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: IA 02257) |
| 152WC0802X Optometrist, Corneal and Contact Management (Licence: NE 1202) | |
| Enumeration Date | 2006-06-22 |
| Last Update Date | 2012-01-28 |