| NPI | 1780747840 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: CT 859) |
| Additional Taxonomies | 152WC0802X Optometrist Corneal and Contact Management (Licence: CT 859) |
| Enumeration Date | 2006-12-19 |
| Last Update Date | 2011-11-30 |