| NPI | 1720058845 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NY TUV0046921) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: CT 002100) |
| Enumeration Date | 2006-01-23 |
| Last Update Date | 2007-07-08 |