| NPI | 1427288992 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: CO 2748) |
| Additional Taxonomies | 152WP0200X Optometrist Pediatrics (Licence: CO 2748) |
| 152WV0400X Optometrist Vision Therapy (Licence: CO 2748) | |
| Enumeration Date | 2009-07-19 |
| Last Update Date | 2022-02-03 |