| NPI | 1861492407 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: SC 1468) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NY UT-003877-1) |
| Enumeration Date | 2005-07-26 |
| Last Update Date | 2008-03-04 |