| NPI | 1588306641 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NY 9782) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: MN 3904) |
| 152W00000X Optometrist (Licence: CT 3385) | |
| 152W00000X Optometrist (Licence: WI 3745) | |
| 152W00000X Optometrist (Licence: IA 114003) | |
| Enumeration Date | 2022-04-10 |
| Last Update Date | 2025-11-17 |