| NPI | 1851953566 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: FL OPC6205) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NY TUV008955-01) |
| Enumeration Date | 2019-07-02 |
| Last Update Date | 2023-05-19 |