| NPI | 1740057280 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NY 006568) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NY 005844) |
| Enumeration Date | 2023-12-05 |
| Last Update Date | 2023-12-05 |