| NPI | 1659722957 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: AZ 2219) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NY 008467) |
| Enumeration Date | 2016-06-28 |
| Last Update Date | 2020-04-09 |