| NPI | 1396900395 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: CO OPT2703) |
| Additional Taxonomies | 152WV0400X Optometrist, Vision Therapy (Licence: NY 007336) |
| Enumeration Date | 2008-07-20 |
| Last Update Date | 2009-08-13 |