| NPI | 1336223858 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 332B00000X Durable Medical Equipment & Medical Supplies (Licence: NY 004632-1) |
| Additional Taxonomies | 156FX1800X Technician/Technologist, Optician (Licence: NY 4632) |
| Enumeration Date | 2006-10-24 |
| Last Update Date | 2009-06-04 |