| NPI | 1366706525 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152WV0400X Optometrist Vision Therapy (Licence: ID ODP-100269) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: CA 14467) |
| Enumeration Date | 2012-07-02 |
| Last Update Date | 2015-07-23 |