| NPI | 1356420798 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NY TUV007040-1) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: AK 252) |
| Enumeration Date | 2006-11-05 |
| Last Update Date | 2019-04-24 |