| NPI | 1336113794 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: CT 002602) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NY VUT006536) |
| Enumeration Date | 2006-02-14 |
| Last Update Date | 2013-03-11 |