| NPI | 1659636546 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 156FX1800X Technician/Technologist, Optician (Licence: NY 7995) |
| Additional Taxonomies | 156FX1201X Technician/Technologist, Optometric Assistant (Licence: NY 7995) |
| Enumeration Date | 2012-07-07 |
| Last Update Date | 2012-07-07 |