| NPI | 1699730440 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: CO OPT-2215) |
| Additional Taxonomies | 152WC0802X Optometrist Corneal and Contact Management (Licence: CO OPT-2215) |
| Enumeration Date | 2006-04-17 |
| Last Update Date | 2008-02-25 |