| NPI | 1245528207 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: CO 3024) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NY TUV007733) |
| Enumeration Date | 2011-07-12 |
| Last Update Date | 2025-05-21 |