| NPI | 1629119797 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NY TUV007141-1) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: OH 4214T78) |
| Enumeration Date | 2007-02-09 |
| Last Update Date | 2012-03-07 |