| NPI | 1447255195 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NY ORT5140-1) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NY VUT5140-1) |
| Enumeration Date | 2005-06-18 |
| Last Update Date | 2024-04-12 |