| NPI | 1295459865 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152WV0400X Optometrist, Vision Therapy (Licence: MI 4901005648) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: MI 4901005648) |
| 152WS0006X Optometrist, Sports Vision (Licence: MI 4901005648) | |
| Enumeration Date | 2022-09-28 |
| Last Update Date | 2022-09-28 |