| NPI | 1801149828 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NY 007947) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: CA 14553) |
| Enumeration Date | 2012-10-16 |
| Last Update Date | 2016-07-12 |