| NPI | 1609088343 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: GA 001589) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NC 1650) |
| 152W00000X Optometrist (Licence: NY T005074) | |
| 152W00000X Optometrist (Licence: NY 005074) | |
| Enumeration Date | 2007-05-04 |
| Last Update Date | 2022-07-21 |