| NPI | 1881892115 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NY 4469) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: OR 1728) |
| 152W00000X Optometrist (Licence: PA OEG003367) | |
| 152W00000X Optometrist (Licence: AZ 660) | |
| 152W00000X Optometrist (Licence: ND 730) | |
| 152W00000X Optometrist (Licence: CA 8124) | |
| 152W00000X Optometrist (Licence: VA 0618002615) | |
| Enumeration Date | 2007-07-09 |
| Last Update Date | 2026-05-27 |