| NPI | 1942754759 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152WC0802X Optometrist Corneal and Contact Management (Licence: GA OPT003068) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: FL OPC5225) |
| Enumeration Date | 2016-08-09 |
| Last Update Date | 2018-02-05 |