| NPI | 1821250952 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: CT 002747) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NY 007288) |
| Enumeration Date | 2008-06-30 |
| Last Update Date | 2014-10-24 |