| NPI | 1629687835 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: CT 003155) |
| Additional Taxonomies | 152WL0500X Optometrist, Low Vision Rehabilitation (Licence: CT 003155) |
| 152WV0400X Optometrist, Vision Therapy (Licence: CT 003155) | |
| Enumeration Date | 2020-07-24 |
| Last Update Date | 2021-09-15 |