| NPI | 1598823510 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: AZ 1434) |
| Additional Taxonomies | 152WC0802X Optometrist, Corneal and Contact Management (Licence: AZ 1434) |
| Enumeration Date | 2006-12-04 |
| Last Update Date | 2009-02-25 |