| NPI | 1578549580 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: MT OPT-OPT-LIC-752) |
| Additional Taxonomies | 152WC0802X Optometrist Corneal and Contact Management (Licence: MT 752) |
| 152WP0200X Optometrist Pediatrics (Licence: MT 752) | |
| Enumeration Date | 2005-12-21 |
| Last Update Date | 2024-03-14 |