| NPI | 1598332983 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: MA OPT5666) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NY TUV009385) |
| Enumeration Date | 2021-06-05 |
| Last Update Date | 2023-12-20 |