| NPI | 1508898925 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: OK 2452) |
| Additional Taxonomies | 152WP0200X Optometrist Pediatrics (Licence: OK 2452) |
| 152WV0400X Optometrist Vision Therapy (Licence: OK 2452) | |
| Enumeration Date | 2006-07-07 |
| Last Update Date | 2007-07-08 |