| NPI | 1619273190 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NY TUV007660) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: TX TX8058TG) |
| Enumeration Date | 2011-02-01 |
| Last Update Date | 2023-10-16 |