| NPI | 1386603058 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 152W00000X Optometrist (Licence: DC OP482) |
| Additional Taxonomies | 152WL0500X Optometrist Low Vision Rehabilitation (Licence: DC OP482) |
| 152WP0200X Optometrist Pediatrics (Licence: DC OP482) | |
| 152WS0006X Optometrist Sports Vision (Licence: DC OP482) | |
| 152WV0400X Optometrist Vision Therapy (Licence: DC OP482) | |
| 152WX0102X Optometrist Occupational Vision (Licence: DC OP482) | |
| Enumeration Date | 2006-03-21 |
| Last Update Date | 2007-07-08 |