| NPI | 1871642207 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NY VUT006286) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: CA 11546TPA) |
| Enumeration Date | 2007-01-08 |
| Last Update Date | 2013-05-10 |