| NPI | 1225313372 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NV 811) |
| Additional Taxonomies | 152WP0200X Optometrist, Pediatrics (Licence: NV 811) |
| 152WV0400X Optometrist, Vision Therapy (Licence: NV 811) | |
| Enumeration Date | 2011-10-19 |
| Last Update Date | 2025-01-27 |