| NPI | 1952395352 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: OH 34.012627) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NH 0733) |
| 152WC0802X Optometrist, Corneal and Contact Management (Licence: NH 0733) | |
| Enumeration Date | 2005-08-31 |
| Last Update Date | 2022-02-28 |