| NPI | 1740482355 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: TN ODT728) |
| Additional Taxonomies | 152WC0802X Optometrist, Corneal and Contact Management (Licence: TN ODT728) |
| Enumeration Date | 2007-06-05 |
| Last Update Date | 2013-03-14 |