| NPI | 1437196631 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NY 006532) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: CT 002684) |
| Enumeration Date | 2006-05-31 |
| Last Update Date | 2010-01-04 |