| NPI | 1508869298 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152WX0102X Optometrist, Occupational Vision (Licence: WV WV723OD) |
| Additional Taxonomies | 152WP0200X Optometrist, Pediatrics (Licence: WV WV723OD) |
| 152WC0802X Optometrist, Corneal and Contact Management (Licence: WV WV723OD) | |
| 152WS0006X Optometrist, Sports Vision (Licence: WV WV723OD) | |
| Enumeration Date | 2005-05-27 |
| Last Update Date | 2007-10-16 |