| NPI | 1396358271 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NC 2615) |
| Additional Taxonomies | 152WC0802X Optometrist, Corneal and Contact Management (Licence: NC 2615) |
| 152WL0500X Optometrist, Low Vision Rehabilitation (Licence: NC 2615) | |
| 152WS0006X Optometrist, Sports Vision (Licence: NC 2615) | |
| 207W00000X Ophthalmology (Licence: NC 2615) | |
| Enumeration Date | 2020-08-28 |
| Last Update Date | 2021-12-28 |