| NPI | 1700132719 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: SC 1696) |
| Additional Taxonomies | 152WC0802X Optometrist, Corneal and Contact Management (Licence: SC 1696) |
| 152WP0200X Optometrist, Pediatrics (Licence: SC 1696) | |
| Enumeration Date | 2012-07-27 |
| Last Update Date | 2015-04-16 |