| NPI | 1881770477 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152WL0500X Optometrist, Low Vision Rehabilitation (Licence: CT 858) |
| Additional Taxonomies | 152WS0006X Optometrist, Sports Vision (Licence: CT 000858) |
| 152WV0400X Optometrist, Vision Therapy (Licence: CT 000858) | |
| 152WP0200X Optometrist, Pediatrics (Licence: CT 000858) | |
| Enumeration Date | 2006-10-27 |
| Last Update Date | 2018-06-05 |