| NPI | 1487616637 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: VA 0618002007) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NY VUT0066551) |
| Enumeration Date | 2006-04-04 |
| Last Update Date | 2011-11-15 |