| NPI | 1629107057 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152WC0802X Optometrist Corneal and Contact Management (Licence: MT 359) |
| Additional Taxonomies | 152WP0200X Optometrist Pediatrics (Licence: MT 359) |
| Enumeration Date | 2007-03-02 |
| Last Update Date | 2009-05-06 |