| NPI | 1881673184 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152WC0802X Optometrist, Corneal and Contact Management (Licence: NY TUV006648-1) |
| Additional Taxonomies | 152WC0802X Optometrist, Corneal and Contact Management (Licence: CA 12450) |
| 152WC0802X Optometrist, Corneal and Contact Management (Licence: FL OPC 4148) | |
| 152WC0802X Optometrist, Corneal and Contact Management (Licence: AZ 1346) | |
| Enumeration Date | 2006-01-13 |
| Last Update Date | 2011-06-28 |