| NPI | 1598843476 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: AL S-910) |
| Additional Taxonomies | 152WC0802X Optometrist, Corneal and Contact Management (Licence: AL S-910) |
| 152WP0200X Optometrist, Pediatrics (Licence: AL S-910) | |
| Enumeration Date | 2006-11-01 |
| Last Update Date | 2013-02-28 |