| NPI | 1184076234 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NY 008491-1) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NY 008491) |
| Enumeration Date | 2016-07-12 |
| Last Update Date | 2022-04-05 |