| NPI | 1922058429 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: MO MO2004006937) |
| Additional Taxonomies | 152WC0802X Optometrist, Corneal and Contact Management (Licence: MO 2004006937) |
| 152WC0802X Optometrist, Corneal and Contact Management (Licence: IA 128991) | |
| Enumeration Date | 2006-05-12 |
| Last Update Date | 2024-11-26 |