| NPI | 1467603258 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NY T4582) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: FL OPC4327) |
| Enumeration Date | 2008-10-10 |
| Last Update Date | 2025-12-23 |