| NPI | 1326200809 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152WV0400X Optometrist, Vision Therapy (Licence: OR 3269ATI) |
| Additional Taxonomies | 152WV0400X Optometrist, Vision Therapy (Licence: WA OD60026416) |
| Enumeration Date | 2008-06-26 |
| Last Update Date | 2008-06-26 |