| NPI | 1790788156 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: CO 1875) |
| Additional Taxonomies | 152WC0802X Optometrist, Corneal and Contact Management (Licence: CO 1875) |
| Enumeration Date | 2005-05-31 |
| Last Update Date | 2023-03-07 |