| NPI | 1619076346 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NY TUV006289-1) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: FL OPC 3623) |
| Enumeration Date | 2006-09-21 |
| Last Update Date | 2019-05-08 |