| NPI | 1831193663 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NV 440) |
| Additional Taxonomies | 152WC0802X Optometrist, Corneal and Contact Management (Licence: NV 440) |
| 152WL0500X Optometrist, Low Vision Rehabilitation (Licence: NV 440) | |
| 152WP0200X Optometrist, Pediatrics (Licence: NV 440) | |
| 152WX0102X Optometrist, Occupational Vision (Licence: NV 440) | |
| Enumeration Date | 2005-06-09 |
| Last Update Date | 2023-08-21 |