| NPI | 1710587340 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: VT 030.0133951) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NY 009224) |
| Enumeration Date | 2020-11-01 |
| Last Update Date | 2022-05-23 |