| NPI | 1629333034 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152WP0200X Optometrist, Pediatrics (Licence: NY TUV007952-1) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: OH 6111) |
| Enumeration Date | 2012-07-11 |
| Last Update Date | 2025-08-27 |