| NPI | 1912468570 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NH 1005) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NY 008925) |
| Enumeration Date | 2019-03-27 |
| Last Update Date | 2024-08-28 |