| NPI | 1770637845 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NY TUV8372-1) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: FL OPC003927) |
| Enumeration Date | 2007-01-23 |
| Last Update Date | 2016-09-07 |