| NPI | 1841378510 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NY 006662) |
| Additional Taxonomies | 152WS0006X Optometrist, Sports Vision (Licence: NY 006662) |
| Enumeration Date | 2006-11-01 |
| Last Update Date | 2021-06-07 |