| NPI | 1548157548 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: AZ OPT-002875) |
| Additional Taxonomies | 152WP0200X Optometrist Pediatrics (Licence: AZ OPT-002875) |
| 152WS0006X Optometrist Sports Vision (Licence: AZ OPT-002875) | |
| 152WV0400X Optometrist Vision Therapy (Licence: AZ OPT-002875) | |
| Enumeration Date | 2025-06-23 |
| Last Update Date | 2025-06-23 |