| NPI | 1275622482 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: MN 2489000) |
| Additional Taxonomies | 152WC0802X Optometrist, Corneal and Contact Management (Licence: MN 2489000) |
| 152WP0200X Optometrist, Pediatrics (Licence: MN 2489000) | |
| 152WS0006X Optometrist, Sports Vision (Licence: MN 2489000) | |
| 152WX0102X Optometrist, Occupational Vision (Licence: MN 2489000) | |
| Enumeration Date | 2006-10-12 |
| Last Update Date | 2025-04-01 |