| NPI | 1750873519 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: FL OPC5881) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NY 008934) |
| Enumeration Date | 2018-06-06 |
| Last Update Date | 2025-08-19 |