| NPI | 1619083714 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: OH OH 4548 T1291) |
| Additional Taxonomies | 152WC0802X Optometrist, Corneal and Contact Management (Licence: OH OH 4548 T1291) |
| 152WP0200X Optometrist, Pediatrics (Licence: OH OH 4548 T1291) | |
| Enumeration Date | 2006-08-22 |
| Last Update Date | 2011-11-17 |