| NPI | 1710993241 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: MO T03341) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NY 006941) |
| Enumeration Date | 2006-08-01 |
| Last Update Date | 2023-05-18 |