| NPI | 1548369689 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NY VUT004828-1) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: PA OE-006832-T) |
| Enumeration Date | 2006-09-22 |
| Last Update Date | 2007-07-08 |