| NPI | 1689765786 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: TN 2951) |
| Additional Taxonomies | 152WV0400X Optometrist, Vision Therapy (Licence: MD TA0816) |
| Enumeration Date | 2006-09-27 |
| Last Update Date | 2021-06-02 |