| NPI | 1750345369 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: VT 030.0059291) |
| Additional Taxonomies | 152WS0006X Optometrist, Sports Vision (Licence: UT 4760909) |
| 152WV0400X Optometrist, Vision Therapy (Licence: UT 4760909) | |
| 152WX0102X Optometrist, Occupational Vision (Licence: UT 4760909) | |
| 152W00000X Optometrist (Licence: UT 4760909) | |
| Enumeration Date | 2006-04-12 |
| Last Update Date | 2023-09-22 |