| NPI | 1821066903 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152WV0400X Optometrist, Vision Therapy (Licence: KS 1105) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NE 829) |
| 152W00000X Optometrist (Licence: KS 1105) | |
| 152WL0500X Optometrist, Low Vision Rehabilitation (Licence: KS 1105) | |
| Enumeration Date | 2006-03-14 |
| Last Update Date | 2015-02-23 |