| NPI | 1598815490 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: GA 915T) |
| Additional Taxonomies | 152WC0802X Optometrist, Corneal and Contact Management (Licence: GA 915T) |
| 152WX0102X Optometrist, Occupational Vision (Licence: GA 915T) | |
| Enumeration Date | 2007-01-11 |
| Last Update Date | 2008-02-14 |