| NPI | 1659360436 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: MN 1916) |
| Additional Taxonomies | 152WC0802X Optometrist, Corneal and Contact Management (Licence: MN 1916) |
| 152WL0500X Optometrist, Low Vision Rehabilitation (Licence: MN 1916) | |
| 152WP0200X Optometrist, Pediatrics (Licence: MN 1916) | |
| 152WS0006X Optometrist, Sports Vision (Licence: MN 1916) | |
| 152WV0400X Optometrist, Vision Therapy (Licence: MN 1916) | |
| Enumeration Date | 2005-10-14 |
| Last Update Date | 2020-09-23 |