| NPI | 1609185693 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: KS KS1966) |
| Additional Taxonomies | 152WC0802X Optometrist, Corneal and Contact Management (Licence: CA 13686 t) |
| Enumeration Date | 2010-09-24 |
| Last Update Date | 2026-07-28 |