| NPI | 1487386181 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: VA 0618003243) |
| Additional Taxonomies | 152WV0400X Optometrist, Vision Therapy (Licence: FL OPC6120) |
| Enumeration Date | 2022-06-30 |
| Last Update Date | 2023-07-07 |