| NPI | 1710471370 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: GA OPT003669) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NY 008789) |
| Enumeration Date | 2018-06-18 |
| Last Update Date | 2025-07-09 |