| NPI | 1740393107 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152WV0400X Optometrist Vision Therapy (Licence: KS 1295) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: KS 1295) |
| 152WP0200X Optometrist Pediatrics (Licence: KS 1295) | |
| Enumeration Date | 2006-08-17 |
| Last Update Date | 2018-05-31 |