| NPI | 1114988862 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152WL0500X Optometrist, Low Vision Rehabilitation (Licence: GA 1052) |
| Additional Taxonomies | 152WL0500X Optometrist, Low Vision Rehabilitation (Licence: TN 871) |
| Enumeration Date | 2006-03-31 |
| Last Update Date | 2007-07-08 |