| NPI | 1205635778 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NY 011279) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: MD 3061) |
| Enumeration Date | 2025-03-10 |
| Last Update Date | 2025-08-12 |