| NPI | 1164566147 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152WL0500X Optometrist, Low Vision Rehabilitation (Licence: VA 0618000774) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: MD TA1159) |
| Enumeration Date | 2007-02-16 |
| Last Update Date | 2008-04-29 |