| NPI | 1477548063 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: DE I3-0011433) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NY 3797-1) |
| Enumeration Date | 2005-09-20 |
| Last Update Date | 2022-01-19 |