| NPI | 1215915731 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 156FX1100X Technician/Technologist, Ophthalmic (Licence: NY 007063-1) |
| Additional Taxonomies | 156FX1100X Technician/Technologist, Ophthalmic (Licence: NJ 34TD00331300) |
| Enumeration Date | 2006-01-04 |
| Last Update Date | 2007-07-08 |