| NPI | 1689965097 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: PA 3348) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NY 007667) |
| Enumeration Date | 2011-04-20 |
| Last Update Date | 2019-01-23 |