| NPI | 1861491946 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NY VUT004901-1) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NV 508) |
| Enumeration Date | 2005-07-20 |
| Last Update Date | 2015-09-03 |