| NPI | 1285631895 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: MN LD1899000) |
| Additional Taxonomies | 152WC0802X Optometrist, Corneal and Contact Management (Licence: MN LD1899000) |
| 152WL0500X Optometrist, Low Vision Rehabilitation (Licence: MN LD1899000) | |
| 152WP0200X Optometrist, Pediatrics (Licence: MN LD1899000) | |
| Enumeration Date | 2005-06-29 |
| Last Update Date | 2007-07-08 |