| NPI | 1417175407 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NY TUV002723-1) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: PA 002723) |
| Enumeration Date | 2007-04-23 |
| Last Update Date | 2009-09-21 |