| NPI | 1982897005 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist |
| Additional Taxonomies | 152WS0006X Optometrist Sports Vision |
| 152WV0400X Optometrist Vision Therapy | |
| Enumeration Date | 2007-08-22 |
| Last Update Date | 2007-08-22 |