| NPI | 1821166570 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NY TUV003193) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NJ 270A00341300) |
| 152W00000X Optometrist (Licence: PA OE004798L) | |
| 152W00000X Optometrist (Licence: CA OPT 6512) | |
| Enumeration Date | 2006-12-01 |
| Last Update Date | 2016-03-07 |