| NPI | 1548253586 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: IA 1623) |
| Additional Taxonomies | 152WC0802X Optometrist, Corneal and Contact Management (Licence: IA 1623) |
| 152WP0200X Optometrist, Pediatrics (Licence: IA 1623) | |
| 152WS0006X Optometrist, Sports Vision (Licence: IA 1623) | |
| 152WV0400X Optometrist, Vision Therapy (Licence: IA 1623) | |
| Enumeration Date | 2005-08-24 |
| Last Update Date | 2007-10-18 |