| NPI | 1801175096 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: VA 0618002227) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NY 007715) |
| Enumeration Date | 2011-08-05 |
| Last Update Date | 2022-02-11 |