| NPI | 1740260041 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: VA 0618001001) |
| Additional Taxonomies | 152WL0500X Optometrist, Low Vision Rehabilitation (Licence: VA 0618001001) |
| Enumeration Date | 2006-01-20 |
| Last Update Date | 2017-04-24 |