| NPI | 1710671565 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NV 1164) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NY ORT010014) |
| Enumeration Date | 2023-06-05 |
| Last Update Date | 2024-09-12 |