| NPI | 1639858194 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NY ORT011092) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: VT 030.0133991) |
| Enumeration Date | 2023-07-12 |
| Last Update Date | 2026-06-23 |