| NPI | 1841605730 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NY TUV008735) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: VA 0618002339) |
| Enumeration Date | 2014-06-30 |
| Last Update Date | 2019-02-27 |