| NPI | 1740279116 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152WV0400X Optometrist, Vision Therapy (Licence: CO OPT.0002330) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: CO 2330) |
| Enumeration Date | 2005-10-18 |
| Last Update Date | 2017-04-07 |