| NPI | 1861441404 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NY TUV004070) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: WI 1784) |
| Enumeration Date | 2006-05-10 |
| Last Update Date | 2011-02-17 |