| NPI | 1750456133 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NY VUT005953) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NY 005953) |
| Enumeration Date | 2006-11-21 |
| Last Update Date | 2020-03-13 |