| NPI | 1861902959 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: MD TA2699) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NY TUV-008611) |
| Enumeration Date | 2017-10-03 |
| Last Update Date | 2019-11-15 |