| NPI | 1780692707 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152WC0802X Optometrist, Corneal and Contact Management (Licence: CT CT2016) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: CT CT2016) |
| 207W00000X Ophthalmology (Licence: CT CT2016) | |
| Enumeration Date | 2006-08-04 |
| Last Update Date | 2025-09-11 |