| NPI | 1942466057 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: AZ 1650) |
| Additional Taxonomies | 152WV0400X Optometrist, Vision Therapy (Licence: AZ 1650) |
| 152W00000X Optometrist (Licence: ID ODP-100172) | |
| Enumeration Date | 2008-07-29 |
| Last Update Date | 2008-09-22 |