| NPI | 1235969072 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NV 1214) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NY 010020) |
| Enumeration Date | 2024-08-06 |
| Last Update Date | 2025-09-25 |