| NPI | 1154474187 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 174400000X Specialist (Licence: CO 1464) |
| Additional Taxonomies | 152WC0802X Optometrist Corneal and Contact Management (Licence: CO 1464) |
| 152WL0500X Optometrist Low Vision Rehabilitation (Licence: CO 1464) | |
| 152WP0200X Optometrist Pediatrics (Licence: CO 1464) | |
| 152WV0400X Optometrist Vision Therapy (Licence: CO 1464) | |
| Enumeration Date | 2007-01-21 |
| Last Update Date | 2014-06-06 |