| NPI | 1578617866 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NY NYS #VUT005234) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: FL OP 2555) |
| Enumeration Date | 2007-01-23 |
| Last Update Date | 2007-07-08 |