| NPI | 1831163484 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NY TOO5266) |
| Additional Taxonomies | 332H00000X Eyewear Supplier (Equipment, not the service) (Licence: NY vut005266) |
| Enumeration Date | 2006-02-13 |
| Last Update Date | 2010-02-04 |