| NPI | 1922589894 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NY 009899) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: MO 2018030741) |
| Enumeration Date | 2018-08-28 |
| Last Update Date | 2025-02-21 |