| NPI | 1255377040 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NV 335) |
| Additional Taxonomies | 152WL0500X Optometrist Low Vision Rehabilitation (Licence: NV 335) |
| Enumeration Date | 2006-06-21 |
| Last Update Date | 2019-02-23 |