| NPI | 1639149222 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152WC0802X Optometrist, Corneal and Contact Management (Licence: OH 3192) |
| Additional Taxonomies | 152WC0802X Optometrist, Corneal and Contact Management (Licence: CA 6311) |
| 152W00000X Optometrist (Licence: OH 3192) | |
| Enumeration Date | 2006-01-25 |
| Last Update Date | 2010-06-09 |