| NPI | 1699751511 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NY TUV003585-1) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NY tuv003585) |
| Enumeration Date | 2005-12-22 |
| Last Update Date | 2024-01-29 |