| NPI | 1235277351 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152WP0200X Optometrist Pediatrics (Licence: SC 1323) |
| Additional Taxonomies | 152WV0400X Optometrist Vision Therapy (Licence: SC 1323) |
| Enumeration Date | 2007-02-01 |
| Last Update Date | 2007-11-21 |