| NPI | 1063569465 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NY 008562) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: MN 2624) |
| Enumeration Date | 2007-01-05 |
| Last Update Date | 2025-01-21 |