| NPI | 1942428362 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152WC0802X Optometrist, Corneal and Contact Management (Licence: GA 001392) |
| Additional Taxonomies | 152WC0802X Optometrist, Corneal and Contact Management (Licence: MI 003669) |
| Enumeration Date | 2007-04-23 |
| Last Update Date | 2007-07-08 |