| NPI | 1235192485 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: LA 1094-298T) |
| Additional Taxonomies | 152WC0802X Optometrist, Corneal and Contact Management (Licence: LA 1094-298T) |
| 152W00000X Optometrist (Licence: LA LA1094-298T) | |
| 152WX0102X Optometrist, Occupational Vision (Licence: LA 1094-298T) | |
| 156FX1800X Technician/Technologist, Optician (Licence: LA 1094-298T) | |
| 152WP0200X Optometrist, Pediatrics (Licence: LA 1094-298T) | |
| 152WS0006X Optometrist, Sports Vision (Licence: LA 1094-298T) | |
| 152WV0400X Optometrist, Vision Therapy (Licence: LA 1094-298T) | |
| Enumeration Date | 2006-04-10 |
| Last Update Date | 2023-09-05 |