| NPI | 1437177656 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152WL0500X Optometrist, Low Vision Rehabilitation (Licence: VA 0618002288) |
| Additional Taxonomies | 152WC0802X Optometrist, Corneal and Contact Management (Licence: TX 7533) |
| 152WS0006X Optometrist, Sports Vision (Licence: MI 4901004024) | |
| Enumeration Date | 2006-07-17 |
| Last Update Date | 2020-09-24 |