| NPI | 1982757829 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: OK OK0852) |
| Additional Taxonomies | 152WC0802X Optometrist, Corneal and Contact Management (Licence: OK 852) |
| 152WS0006X Optometrist, Sports Vision (Licence: OK 852) | |
| 152WX0102X Optometrist, Occupational Vision (Licence: OK 852) | |
| 156FX1900X Technician/Technologist, Orthoptist (Licence: OK 852) | |
| Enumeration Date | 2007-01-22 |
| Last Update Date | 2014-03-17 |