| NPI | 1225010721 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152WL0500X Optometrist, Low Vision Rehabilitation (Licence: PR OD215) |
| Additional Taxonomies | 152WL0500X Optometrist, Low Vision Rehabilitation (Licence: PR 215) |
| Enumeration Date | 2005-11-18 |
| Last Update Date | 2011-01-10 |