| NPI | 1083781611 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NY TUV003328) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NY 003328) |
| Enumeration Date | 2006-11-29 |
| Last Update Date | 2008-12-18 |