| NPI | 1619528981 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: DC OP1000410) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NY 009054) |
| Enumeration Date | 2019-09-26 |
| Last Update Date | 2020-10-25 |