| NPI | 1972507614 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: TN odt2014) |
| Additional Taxonomies | 152WP0200X Optometrist, Pediatrics (Licence: TN odt2014) |
| 152WV0400X Optometrist, Vision Therapy (Licence: TN odt2014) | |
| Enumeration Date | 2005-06-10 |
| Last Update Date | 2008-02-13 |