| NPI | 1770218620 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: CT 003307) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NY TUV009571) |
| Enumeration Date | 2022-07-22 |
| Last Update Date | 2024-03-15 |