| NPI | 1801221346 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NY 008071) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NY 8071) |
| Enumeration Date | 2013-09-03 |
| Last Update Date | 2023-06-29 |