| NPI | 1922091354 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152WL0500X Optometrist, Low Vision Rehabilitation (Licence: TN OD000000538) |
| Additional Taxonomies | 152WX0102X Optometrist, Occupational Vision (Licence: TN OD000000538) |
| 152W00000X Optometrist (Licence: TN OD000000538) | |
| 152WV0400X Optometrist, Vision Therapy (Licence: TN OD000000538) | |
| Enumeration Date | 2005-08-31 |
| Last Update Date | 2018-03-17 |