| NPI | 1417079575 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: VA 0618-000735) |
| Additional Taxonomies | 152WV0400X Optometrist, Vision Therapy (Licence: VA 0618-000735) |
| Enumeration Date | 2007-04-06 |
| Last Update Date | 2007-07-09 |