| NPI | 1144459538 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: TN 2878) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NY TUV007413-1) |
| Enumeration Date | 2009-07-07 |
| Last Update Date | 2009-11-13 |