| NPI | 1720012891 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NY TUV004726-1) |
| Additional Taxonomies | 156FX1800X Technician/Technologist, Optician (Licence: NY 4715) |
| 156FX1800X Technician/Technologist, Optician (Licence: NY 6545) | |
| Enumeration Date | 2006-07-11 |
| Last Update Date | 2007-12-28 |