| NPI | 1720463201 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: ID ODP-100331) |
| Additional Taxonomies | 152WC0802X Optometrist, Corneal and Contact Management (Licence: ID ODP100331) |
| Enumeration Date | 2015-07-24 |
| Last Update Date | 2023-07-03 |