| NPI | 1588157291 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: SC OPT.2201) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NY TUV008748) |
| Enumeration Date | 2018-06-08 |
| Last Update Date | 2023-01-12 |