| NPI | 1871520973 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: MA 3317) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NY TUY004734-1) |
| Enumeration Date | 2006-06-26 |
| Last Update Date | 2009-04-30 |