| NPI | 1679841373 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NY 007803) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: CA 14337) |
| Enumeration Date | 2011-12-08 |
| Last Update Date | 2022-03-12 |