| NPI | 1992718662 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152WC0802X Optometrist, Corneal and Contact Management (Licence: AZ OPT-002329) |
| Additional Taxonomies | 152WC0802X Optometrist, Corneal and Contact Management (Licence: CA 12305 T) |
| Enumeration Date | 2006-08-14 |
| Last Update Date | 2020-07-21 |