| NPI | 1952357527 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NY T006276) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NJ 27OA00579100) |
| Enumeration Date | 2006-05-25 |
| Last Update Date | 2007-07-08 |