| NPI | 1457313363 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: NC 2005-00746) |
| Additional Taxonomies | 152WV0400X Optometrist, Vision Therapy (Licence: NC 2005-00746) |
| Enumeration Date | 2006-04-05 |
| Last Update Date | 2022-05-24 |