| NPI | 1144296286 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: WV 1027-OD) |
| Additional Taxonomies | 152WL0500X Optometrist, Low Vision Rehabilitation (Licence: WV 1027-OD) |
| 152WV0400X Optometrist, Vision Therapy (Licence: WV 1027-OD) | |
| Enumeration Date | 2006-02-28 |
| Last Update Date | 2007-12-06 |