| NPI | 1215369236 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: LA 1657-691T) |
| Additional Taxonomies | 152WC0802X Optometrist, Corneal and Contact Management (Licence: LA 1657-691T) |
| 152WL0500X Optometrist, Low Vision Rehabilitation (Licence: LA 1657-691T) | |
| 152WS0006X Optometrist, Sports Vision (Licence: LA 1657-691T) | |
| Enumeration Date | 2013-07-31 |
| Last Update Date | 2014-10-21 |