| NPI | 1467971200 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NY 009743) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: MD TA2594) |
| Enumeration Date | 2017-09-13 |
| Last Update Date | 2024-03-01 |