| NPI | 1578520094 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: AZ 062) |
| Additional Taxonomies | 152WC0802X Optometrist, Corneal and Contact Management (Licence: AZ 062) |
| Enumeration Date | 2006-04-27 |
| Last Update Date | 2020-09-12 |