| NPI | 1497788764 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: CT 002795) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NY TUV007383) |
| Enumeration Date | 2006-07-09 |
| Last Update Date | 2011-04-22 |