| NPI | 1982737607 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: CO OPT2383) |
| Additional Taxonomies | 152WP0200X Optometrist, Pediatrics (Licence: CO OPT2383) |
| 152WS0006X Optometrist, Sports Vision (Licence: CO OPT2383) | |
| 152WV0400X Optometrist, Vision Therapy (Licence: CO OPT2383) | |
| Enumeration Date | 2007-03-13 |
| Last Update Date | 2019-06-27 |