| NPI | 1841474731 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: OR 1642 ATI) |
| Additional Taxonomies | 152WC0802X Optometrist Corneal and Contact Management (Licence: OR 1642 ATI) |
| 152WP0200X Optometrist Pediatrics (Licence: OR 1642ATI) | |
| 152WL0500X Optometrist Low Vision Rehabilitation (Licence: OR 1642ATI) | |
| Enumeration Date | 2007-12-27 |
| Last Update Date | 2008-02-10 |