| NPI | 1699934430 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: MN 3351) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NY 007295) |
| Enumeration Date | 2008-06-06 |
| Last Update Date | 2016-06-22 |