| NPI | 1336600634 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: VA 0618003085) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NY TUV009230) |
| Enumeration Date | 2019-03-28 |
| Last Update Date | 2023-09-12 |