| NPI | 1609527613 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: OR ATI4607) |
| Additional Taxonomies | 152WV0400X Optometrist, Vision Therapy (Licence: OR ATI4607) |
| Enumeration Date | 2022-01-11 |
| Last Update Date | 2024-02-15 |