| NPI | 1760832984 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NY 008417) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NY TUV008417-1) |
| Enumeration Date | 2016-06-18 |
| Last Update Date | 2019-07-10 |