| NPI | 1619943370 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: TX 10795) |
| Additional Taxonomies | 152WC0802X Optometrist, Corneal and Contact Management (Licence: CA 12504 TPA) |
| 152WC0802X Optometrist, Corneal and Contact Management (Licence: AZ 1439) | |
| 152WC0802X Optometrist, Corneal and Contact Management (Licence: NV 781) | |
| Enumeration Date | 2006-02-23 |
| Last Update Date | 2023-07-26 |