| NPI | 1295459865 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152WV0400X Optometrist, Vision Therapy (Licence: MD TA2980) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: MD TA2980) |
| 152WP0200X Optometrist, Pediatrics (Licence: MD TA2980) | |
| 152WS0006X Optometrist, Sports Vision (Licence: MD TA2980) | |
| Enumeration Date | 2022-09-28 |
| Last Update Date | 2024-12-11 |