| NPI | 1740251529 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: OR 3650AT) |
| Additional Taxonomies | 152WS0006X Optometrist, Sports Vision (Licence: OR 3650AT) |
| 152WC0802X Optometrist, Corneal and Contact Management (Licence: OR 3650AT) | |
| 152WV0400X Optometrist, Vision Therapy (Licence: OR 3650AT) | |
| 152WP0200X Optometrist, Pediatrics (Licence: OR 3650AT) | |
| 152WX0102X Optometrist, Occupational Vision (Licence: OR 3650AT) | |
| Enumeration Date | 2006-01-30 |
| Last Update Date | 2025-11-14 |