| NPI | 1518370840 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: FL OPC5034) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NY 008126) |
| Enumeration Date | 2014-06-04 |
| Last Update Date | 2025-03-28 |