| NPI | 1659997252 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152WV0400X Optometrist, Vision Therapy (Licence: IL 046011422) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: MI 4901005432) |
| Enumeration Date | 2020-06-19 |
| Last Update Date | 2022-10-24 |