| NPI | 1003461880 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NY 009133) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: CT 3110) |
| Enumeration Date | 2019-08-07 |
| Last Update Date | 2020-06-25 |