| NPI | 1952395253 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: VT 030.0066965) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NY 007251TUV) |
| Enumeration Date | 2005-09-01 |
| Last Update Date | 2024-02-23 |