| NPI | 1033559026 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: ID ODP:100311) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: CA 14652) |
| 152WP0200X Optometrist, Pediatrics (Licence: ID ODP:100311) | |
| 152WP0200X Optometrist, Pediatrics (Licence: CA 14652) | |
| 152WS0006X Optometrist, Sports Vision (Licence: ID ODP:100311) | |
| 152WV0400X Optometrist, Vision Therapy (Licence: ID ODP:100311) | |
| 152WV0400X Optometrist, Vision Therapy (Licence: CA 14652) | |
| Enumeration Date | 2013-07-05 |
| Last Update Date | 2019-09-18 |