| NPI | 1912908658 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: LA 1411-553T) |
| Additional Taxonomies | 152WP0200X Optometrist, Pediatrics (Licence: LA 1411-553T) |
| 152WV0400X Optometrist, Vision Therapy (Licence: LA 1411-553T) | |
| 152WC0802X Optometrist, Corneal and Contact Management (Licence: LA 1411-553T) | |
| 152WL0500X Optometrist, Low Vision Rehabilitation (Licence: LA 1411-553T) | |
| Enumeration Date | 2005-08-03 |
| Last Update Date | 2016-12-02 |