| NPI | 1659448157 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NY TUV006689-1) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NJ 27oa00606500) |
| Enumeration Date | 2006-11-29 |
| Last Update Date | 2010-08-19 |