| NPI | 1689689101 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: KY KY1973DT) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NJ 27OA00340800) |
| Enumeration Date | 2006-07-31 |
| Last Update Date | 2016-01-27 |