| NPI | 1669470530 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NY TUV5891) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: TN OD2344) |
| Enumeration Date | 2005-07-13 |
| Last Update Date | 2008-05-13 |