| NPI | 1780847483 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152WC0802X Optometrist, Corneal and Contact Management (Licence: PA OEG002070) |
| Additional Taxonomies | 152WC0802X Optometrist, Corneal and Contact Management (Licence: LA 1562-595T) |
| Enumeration Date | 2008-07-03 |
| Last Update Date | 2018-08-21 |