| NPI | 1942983465 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: VA 0618003397) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NY 009891) |
| Enumeration Date | 2023-08-10 |
| Last Update Date | 2024-10-14 |