| NPI | 1982915484 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NY 007563) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: OR 3532AT) |
| Enumeration Date | 2010-06-30 |
| Last Update Date | 2014-09-25 |