| NPI | 1093706327 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NY 006772) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: VA 0618001505) |
| Enumeration Date | 2005-11-04 |
| Last Update Date | 2021-04-16 |