| NPI | 1477106201 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NY 008949) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NY 00849) |
| Enumeration Date | 2019-07-21 |
| Last Update Date | 2022-03-07 |