| NPI | 1952338071 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: OR 2183T) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: MN 2347) |
| 152WP0200X Optometrist, Pediatrics (Licence: OR 2183T) | |
| 152WV0400X Optometrist, Vision Therapy (Licence: OR 2183T) | |
| Enumeration Date | 2006-06-26 |
| Last Update Date | 2013-10-01 |