| NPI | 1659467587 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NY vut006039) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: FL Opc3316) |
| 152W00000X Optometrist (Licence: UT 14271910-9934) | |
| Enumeration Date | 2006-10-05 |
| Last Update Date | 2026-06-01 |