| NPI | 1598824369 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: HI 505) |
| Additional Taxonomies | 152WC0802X Optometrist, Corneal and Contact Management (Licence: CA 12075) |
| Enumeration Date | 2006-12-08 |
| Last Update Date | 2009-09-09 |