| NPI | 1871750133 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: MD TA2084) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: GA OPT002572) |
| 152W00000X Optometrist (Licence: VA 0618002532) | |
| 152WC0802X Optometrist, Corneal and Contact Management (Licence: MD DA 2084) | |
| 152WS0006X Optometrist, Sports Vision (Licence: MD DA 2084) | |
| Enumeration Date | 2008-05-22 |
| Last Update Date | 2023-08-09 |