| NPI | 1922301977 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: PR 681) |
| Additional Taxonomies | 152WC0802X Optometrist, Corneal and Contact Management (Licence: PR 681) |
| 152WV0400X Optometrist, Vision Therapy (Licence: PR 681) | |
| Enumeration Date | 2010-12-14 |
| Last Update Date | 2010-12-14 |