| NPI | 1417950775 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: OK 1193) |
| Additional Taxonomies | 152WV0400X Optometrist Vision Therapy (Licence: OK 1193) |
| Enumeration Date | 2005-05-31 |
| Last Update Date | 2010-05-11 |