| NPI | 1740289990 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: AZ AZ224) |
| Additional Taxonomies | 152WL0500X Optometrist, Low Vision Rehabilitation (Licence: AZ AZ224) |
| 152WX0102X Optometrist, Occupational Vision (Licence: AZ AZ224) | |
| Enumeration Date | 2005-07-19 |
| Last Update Date | 2010-08-13 |