| NPI | 1639171960 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: MD TA1522) |
| Additional Taxonomies | 152WC0802X Optometrist, Corneal and Contact Management (Licence: MD TA1522) |
| 152WV0400X Optometrist, Vision Therapy (Licence: MD TA1522) | |
| Enumeration Date | 2005-05-31 |
| Last Update Date | 2007-12-14 |