| NPI | 1396814091 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152WC0802X Optometrist, Corneal and Contact Management (Licence: OR 1813T) |
| Additional Taxonomies | 152WP0200X Optometrist, Pediatrics (Licence: OR 1813T) |
| 152WV0400X Optometrist, Vision Therapy (Licence: OR 1813T) | |
| Enumeration Date | 2006-11-07 |
| Last Update Date | 2007-07-08 |