| NPI | 1417284720 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: FL opc4627) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NY 56007503) |
| Enumeration Date | 2009-11-06 |
| Last Update Date | 2023-06-01 |