| NPI | 1629777545 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NY RT009883) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: CA 35378) |
| Enumeration Date | 2023-02-28 |
| Last Update Date | 2023-08-07 |