| NPI | 1659997252 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: FL OPC6211) |
| Additional Taxonomies | 152WV0400X Optometrist, Vision Therapy (Licence: IL 046011422) |
| 152W00000X Optometrist (Licence: MI 4901005432) | |
| Enumeration Date | 2020-06-19 |
| Last Update Date | 2025-08-21 |