| NPI | 1982795480 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152WC0802X Optometrist, Corneal and Contact Management (Licence: MO T03097) |
| Additional Taxonomies | 152WC0802X Optometrist, Corneal and Contact Management (Licence: KS KS1343-3) |
| Enumeration Date | 2006-09-28 |
| Last Update Date | 2007-07-08 |