| NPI | 1922073071 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NY tuv006607) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: PA 008914) |
| Enumeration Date | 2006-02-22 |
| Last Update Date | 2018-09-27 |