| NPI | 1144740788 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NC 2509) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NY TUV008593) |
| Enumeration Date | 2017-06-25 |
| Last Update Date | 2021-04-18 |