| NPI | 1255324299 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152WV0400X Optometrist, Vision Therapy (Licence: ID ODP 100160) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: UT 5948980-9934) |
| Enumeration Date | 2005-08-24 |
| Last Update Date | 2008-09-10 |