| NPI | 1649244674 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NC 2252) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NY VUT 005474) |
| Enumeration Date | 2006-02-15 |
| Last Update Date | 2018-03-17 |