| NPI | 1730277971 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: VT 030-0000235) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NY T005921-1) |
| Enumeration Date | 2006-10-11 |
| Last Update Date | 2007-07-08 |