| NPI | 1487657912 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: AL S-983-TA 555) |
| Additional Taxonomies | 152WC0802X Optometrist Corneal and Contact Management (Licence: AL S983TA555) |
| 152WL0500X Optometrist Low Vision Rehabilitation (Licence: AL S983TA555) | |
| 152WV0400X Optometrist Vision Therapy (Licence: AL S-983-TA-555) | |
| Enumeration Date | 2005-05-30 |
| Last Update Date | 2022-04-18 |