| NPI | 1619126307 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: IA 002569) |
| Additional Taxonomies | 152WC0802X Optometrist, Corneal and Contact Management (Licence: NC 2108) |
| Enumeration Date | 2008-09-17 |
| Last Update Date | 2019-05-15 |