| NPI | 1386121432 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: CO OPT.0003424) |
| Additional Taxonomies | 152WC0802X Optometrist, Corneal and Contact Management (Licence: CO OPT.0003424) |
| 152WL0500X Optometrist, Low Vision Rehabilitation (Licence: CO OPT.0003424) | |
| 152WP0200X Optometrist, Pediatrics (Licence: CO OPT.0003424) | |
| Enumeration Date | 2018-07-22 |
| Last Update Date | 2021-05-23 |