| NPI | 1548226822 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: SC 503) |
| Additional Taxonomies | 152WC0802X Optometrist Corneal and Contact Management (Licence: SC 503) |
| 152WP0200X Optometrist Pediatrics (Licence: SC 503) | |
| 152WS0006X Optometrist Sports Vision (Licence: SC 503) | |
| 152WV0400X Optometrist Vision Therapy (Licence: SC 503) | |
| Enumeration Date | 2006-04-25 |
| Last Update Date | 2007-11-15 |