| NPI | 1942305818 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NY TUV005011) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: PA 0EG000607) |
| Enumeration Date | 2006-09-14 |
| Last Update Date | 2016-10-31 |