| NPI | 1629029012 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: MD TAO866) |
| Additional Taxonomies | 152WV0400X Optometrist, Vision Therapy (Licence: MD TAO866) |
| Enumeration Date | 2006-05-12 |
| Last Update Date | 2010-12-15 |