| NPI | 1235343559 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NY 006867) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: TX 8627) |
| Enumeration Date | 2007-05-09 |
| Last Update Date | 2016-02-04 |