| NPI | 1962441220 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: MO T03361) |
| Additional Taxonomies | 152WC0802X Optometrist Corneal and Contact Management (Licence: MO TO3361) |
| Enumeration Date | 2006-06-05 |
| Last Update Date | 2018-05-18 |