| NPI | 1437646791 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NY TUV008775-1) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NY TUV008775) |
| 390200000X Student in an Organized Health Care Education/Training Program | |
| Enumeration Date | 2018-04-21 |
| Last Update Date | 2019-01-23 |