| NPI | 1578979258 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: CT 2964) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NY TUV008156-1) |
| Enumeration Date | 2014-07-02 |
| Last Update Date | 2022-08-01 |