| NPI | 1821582818 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NY TUV008745-1) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: TX 9462TG) |
| 152W00000X Optometrist (Licence: OH OPT.007326) | |
| Enumeration Date | 2018-06-21 |
| Last Update Date | 2024-07-24 |