| NPI | 1518954510 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152WV0400X Optometrist, Vision Therapy (Licence: TX 2196T) |
| Additional Taxonomies | 152WV0400X Optometrist, Vision Therapy (Licence: CO 2470) |
| Enumeration Date | 2005-10-04 |
| Last Update Date | 2008-06-12 |