| NPI | 1679654180 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: SC 1590) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NY VUT005016) |
| Enumeration Date | 2006-10-18 |
| Last Update Date | 2025-01-14 |