| NPI | 1831193432 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152WV0400X Optometrist, Vision Therapy (Licence: OR 961AT) |
| Additional Taxonomies | 133N00000X Nutritionist (Licence: OR 79-807) |
| 152WV0400X Optometrist, Vision Therapy (Licence: OR 961 AT) | |
| Enumeration Date | 2005-06-10 |
| Last Update Date | 2011-08-01 |