| NPI | 1114110467 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NY 008535) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: MD TA2333) |
| Enumeration Date | 2007-08-21 |
| Last Update Date | 2017-01-11 |