| NPI | 1770608788 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: MD DA0890) |
| Additional Taxonomies | 152WC0802X Optometrist, Corneal and Contact Management (Licence: MD DA0890) |
| 152WP0200X Optometrist, Pediatrics (Licence: MD DA0890) | |
| 152WV0400X Optometrist, Vision Therapy (Licence: MD DA0890) | |
| 152WX0102X Optometrist, Occupational Vision (Licence: MD DA0890) | |
| Enumeration Date | 2007-03-20 |
| Last Update Date | 2007-07-08 |