| NPI | 1669470589 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: SD 4579) |
| Additional Taxonomies | 156FC0800X Technician/Technologist, Contact Lens (Licence: SD 4579) |
| Enumeration Date | 2005-07-13 |
| Last Update Date | 2008-04-24 |