| NPI | 1649225277 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NY VOT3547) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NY TOV0035471) |
| Enumeration Date | 2006-05-23 |
| Last Update Date | 2008-01-14 |