| NPI | 1679576102 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NY VUT004810-1) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NE 1195) |
| Enumeration Date | 2005-05-30 |
| Last Update Date | 2020-03-17 |