| NPI | 1639292147 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152WC0802X Optometrist, Corneal and Contact Management (Licence: MN 2808) |
| Additional Taxonomies | 152WC0802X Optometrist, Corneal and Contact Management (Licence: OH 5110) |
| Enumeration Date | 2007-04-09 |
| Last Update Date | 2007-07-08 |