| NPI | 1336241322 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152WX0102X Optometrist, Occupational Vision (Licence: NY TUV006554-1) |
| Additional Taxonomies | 332H00000X Eyewear Supplier (Equipment, not the service) |
| Enumeration Date | 2006-09-01 |
| Last Update Date | 2021-10-25 |