| NPI | 1902110620 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: LA 1594-627T) |
| Additional Taxonomies | 152WC0802X Optometrist, Corneal and Contact Management (Licence: LA 1594-627T) |
| Enumeration Date | 2010-08-05 |
| Last Update Date | 2012-01-05 |