| NPI | 1952365702 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: SC 656) |
| Additional Taxonomies | 152WV0400X Optometrist, Vision Therapy (Licence: SC 656) |
| 156FX1800X Technician/Technologist, Optician (Licence: SC 656) | |
| Enumeration Date | 2006-04-17 |
| Last Update Date | 2014-03-11 |