| NPI | 1679641062 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NY TUV007126-1) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: FL OPC4132) |
| 152W00000X Optometrist (Licence: NJ 27OA00619000) | |
| Enumeration Date | 2006-12-01 |
| Last Update Date | 2011-04-29 |