| NPI | 1124138193 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: MO T02916) |
| Additional Taxonomies | 152WP0200X Optometrist, Pediatrics (Licence: MO t02916) |
| 152WV0400X Optometrist, Vision Therapy (Licence: MO T02916) | |
| Enumeration Date | 2006-08-30 |
| Last Update Date | 2020-06-10 |