| NPI | 1730180704 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152WL0500X Optometrist, Low Vision Rehabilitation (Licence: TN OD0000002541) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: TN OD2541) |
| Enumeration Date | 2005-08-02 |
| Last Update Date | 2021-01-22 |