| NPI | 1295704559 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: MA 5210) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NY TUV-004197) |
| Enumeration Date | 2006-03-17 |
| Last Update Date | 2019-12-22 |