| NPI | 1457392466 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NC NC 1366) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NY NY 005118) |
| Enumeration Date | 2006-06-09 |
| Last Update Date | 2020-12-11 |