| NPI | 1619317302 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: MO 2013020411) |
| Additional Taxonomies | 152WC0802X Optometrist, Corneal and Contact Management (Licence: MO 2013020411) |
| Enumeration Date | 2013-06-27 |
| Last Update Date | 2013-09-26 |