| NPI | 1649667122 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NY TUV009508) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: CT 002997) |
| 152W00000X Optometrist (Licence: NH 0905) | |
| Enumeration Date | 2015-04-22 |
| Last Update Date | 2023-08-09 |