| NPI | 1215974548 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152WL0500X Optometrist, Low Vision Rehabilitation (Licence: NC 1267) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NC 1267) |
| 152WL0500X Optometrist, Low Vision Rehabilitation (Licence: SC 1182) | |
| Enumeration Date | 2006-06-02 |
| Last Update Date | 2021-03-17 |