| NPI | 1154352631 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: CO 1628) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NM 604) |
| 152W00000X Optometrist (Licence: MT 592) | |
| 152WL0500X Optometrist, Low Vision Rehabilitation (Licence: NM 604) | |
| 152WL0500X Optometrist, Low Vision Rehabilitation (Licence: MT 592) | |
| 152WL0500X Optometrist, Low Vision Rehabilitation (Licence: CO 1628) | |
| Enumeration Date | 2006-07-05 |
| Last Update Date | 2020-04-15 |