| NPI | 1811918360 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NE 1178) |
| Additional Taxonomies | 152WC0802X Optometrist Corneal and Contact Management (Licence: NE 1178) |
| 152WP0200X Optometrist Pediatrics (Licence: NE 1178) | |
| 152WS0006X Optometrist Sports Vision (Licence: NE 1178) | |
| Enumeration Date | 2006-07-21 |
| Last Update Date | 2020-01-02 |