| NPI | 1104826528 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NC NC 1652) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NJ 4872) |
| 152W00000X Optometrist (Licence: PA 6828) | |
| 152WC0802X Optometrist, Corneal and Contact Management (Licence: NC 1652) | |
| 152WL0500X Optometrist, Low Vision Rehabilitation (Licence: NC 1652) | |
| 152WP0200X Optometrist, Pediatrics (Licence: NC 1652) | |
| 152WS0006X Optometrist, Sports Vision (Licence: NC 1652) | |
| 152WX0102X Optometrist, Occupational Vision (Licence: NC 1652) | |
| Enumeration Date | 2005-07-28 |
| Last Update Date | 2024-10-23 |