| NPI | 1891714390 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152WP0200X Optometrist Pediatrics (Licence: PR 398) |
| Additional Taxonomies | 152WV0400X Optometrist Vision Therapy (Licence: PR 398) |
| 152W00000X Optometrist (Licence: PR 398) | |
| Enumeration Date | 2006-07-18 |
| Last Update Date | 2007-07-08 |