| NPI | 1437338266 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NY 0003785) |
| Additional Taxonomies | 332H00000X Eyewear Supplier (Equipment, not the service) (Licence: NY P017003785) |
| Enumeration Date | 2007-10-29 |
| Last Update Date | 2009-04-24 |