| NPI | 1346316718 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NY 005672) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NY TUV005672-1) |
| Enumeration Date | 2006-11-28 |
| Last Update Date | 2022-08-02 |