| NPI | 1255318861 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NY TUV005303-1) |
| Additional Taxonomies | 332H00000X Eyewear Supplier (Licence: NY TUV005303-1) |
| Enumeration Date | 2005-12-23 |
| Last Update Date | 2024-08-01 |