| NPI | 1316921679 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: AZ 913) |
| Additional Taxonomies | 152WL0500X Optometrist Low Vision Rehabilitation (Licence: AZ 913) |
| 152WV0400X Optometrist Vision Therapy (Licence: AZ 913) | |
| Enumeration Date | 2005-11-30 |
| Last Update Date | 2019-10-22 |