| NPI | 1578233359 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NY 009637) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: CA 34896) |
| Enumeration Date | 2021-09-14 |
| Last Update Date | 2024-01-10 |