| NPI | 1982042925 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: MN 3362) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NY 008021) |
| Enumeration Date | 2013-06-12 |
| Last Update Date | 2015-11-10 |