| NPI | 1841969995 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 156FX1800X Technician/Technologist, Optician (Licence: NY 009419) |
| Additional Taxonomies | 156FX1100X Technician/Technologist, Ophthalmic |
| Enumeration Date | 2021-09-12 |
| Last Update Date | 2021-09-12 |