| NPI | 1245878263 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NY TUV009087-01) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: FL TPOP30) |
| Enumeration Date | 2019-12-20 |
| Last Update Date | 2024-03-29 |