| NPI | 1285657296 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152WL0500X Optometrist Low Vision Rehabilitation (Licence: LA 970-277T) |
| Additional Taxonomies | 152WC0802X Optometrist Corneal and Contact Management (Licence: LA 970-277T) |
| Enumeration Date | 2006-07-25 |
| Last Update Date | 2010-01-11 |