| NPI | 1952824211 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NY 009237) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: WA OD60770099) |
| Enumeration Date | 2017-07-19 |
| Last Update Date | 2025-03-21 |