| NPI | 1699384974 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: FL OPC5867) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NY TUV009148-01) |
| Enumeration Date | 2020-07-23 |
| Last Update Date | 2023-03-15 |