| NPI | 1588617005 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NY VUT006229) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: TN OD0000002412) |
| Enumeration Date | 2006-05-18 |
| Last Update Date | 2011-05-25 |