| NPI | 1760589006 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: CT 002021) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NY 3500) |
| Enumeration Date | 2006-09-20 |
| Last Update Date | 2007-07-08 |