| NPI | 1518923556 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: MD TA1949) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NY V6589) |
| Enumeration Date | 2006-04-26 |
| Last Update Date | 2013-02-11 |