| NPI | 1659167203 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152WV0400X Optometrist, Vision Therapy (Licence: OR 4781) |
| Additional Taxonomies | 152WL0500X Optometrist, Low Vision Rehabilitation (Licence: OR 4781) |
| 152WP0200X Optometrist, Pediatrics (Licence: OR 4781) | |
| 152WS0006X Optometrist, Sports Vision (Licence: OR 4781) | |
| Enumeration Date | 2025-04-18 |
| Last Update Date | 2025-06-19 |