| NPI | 1386618999 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NY vut006224) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NY T006224) |
| Enumeration Date | 2006-02-13 |
| Last Update Date | 2007-09-21 |