| NPI | 1790757110 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152WC0802X Optometrist Corneal and Contact Management (Licence: UT 348323-8904) |
| Additional Taxonomies | 152WP0200X Optometrist Pediatrics (Licence: UT 348323-9934) |
| 152WS0006X Optometrist Sports Vision (Licence: UT 348323-9934) | |
| Enumeration Date | 2006-02-02 |
| Last Update Date | 2008-06-02 |