| NPI | 1346223831 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152WV0400X Optometrist Vision Therapy (Licence: CO OPT-874) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: CO OPT-874) |
| 152WC0802X Optometrist Corneal and Contact Management (Licence: CO OPT-874) | |
| 152WP0200X Optometrist Pediatrics (Licence: CO OPT-874) | |
| Enumeration Date | 2005-11-29 |
| Last Update Date | 2007-11-28 |