| NPI | 1720009178 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152WL0500X Optometrist, Low Vision Rehabilitation (Licence: MO 2394) |
| Additional Taxonomies | 152WL0500X Optometrist, Low Vision Rehabilitation (Licence: KS 1158-3) |
| Enumeration Date | 2006-07-21 |
| Last Update Date | 2007-07-10 |