| NPI | 1922417518 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NY 008704) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: CA 15205TLG) |
| Enumeration Date | 2014-08-07 |
| Last Update Date | 2021-12-06 |