| NPI | 1922413723 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152WV0400X Optometrist, Vision Therapy (Licence: OR 3639ATI) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: MO 2014018414) |
| Enumeration Date | 2014-07-01 |
| Last Update Date | 2018-07-24 |