| NPI | 1952031379 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NY TUV009588) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NY 009588) |
| Enumeration Date | 2022-06-16 |
| Last Update Date | 2023-03-27 |