| NPI | 1811090442 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: FL 3799) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NY TUV006880) |
| 152W00000X Optometrist (Licence: CT 002663) | |
| Enumeration Date | 2006-09-07 |
| Last Update Date | 2007-07-08 |