| NPI | 1710415674 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NY TUV008654) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: CA OPT33871-TLG) |
| Enumeration Date | 2017-05-23 |
| Last Update Date | 2018-03-17 |