| NPI | 1790092914 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152WV0400X Optometrist, Vision Therapy (Licence: IA 002511) |
| Additional Taxonomies | 152WP0200X Optometrist, Pediatrics (Licence: IA 002511) |
| 152W00000X Optometrist (Licence: IA 002511) | |
| Enumeration Date | 2010-09-09 |
| Last Update Date | 2016-11-30 |