| NPI | 1932107307 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: VA 0618001441) |
| Additional Taxonomies | 152WC0802X Optometrist, Corneal and Contact Management (Licence: VA 0618001441) |
| 152WP0200X Optometrist, Pediatrics (Licence: VA 0618001441) | |
| Enumeration Date | 2005-07-11 |
| Last Update Date | 2011-08-19 |