| NPI | 1609205152 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: WI 3327-35) |
| Additional Taxonomies | 152WC0802X Optometrist, Corneal and Contact Management (Licence: WI 3327-35) |
| Enumeration Date | 2013-11-05 |
| Last Update Date | 2017-10-05 |