| NPI | 1992149561 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NY 005938) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: MA 423) |
| Enumeration Date | 2013-04-25 |
| Last Update Date | 2013-04-25 |