| NPI | 1184460115 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: NY 009982) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NY 009982) |
| Enumeration Date | 2024-07-09 |
| Last Update Date | 2025-08-20 |