| NPI | 1851438048 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist |
| Additional Taxonomies | 152WC0802X Optometrist Corneal and Contact Management |
| 152WP0200X Optometrist Pediatrics | |
| 152WV0400X Optometrist Vision Therapy | |
| Enumeration Date | 2007-01-30 |
| Last Update Date | 2007-07-08 |