| NPI | 1851322861 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NY 003634) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NY 3634) |
| Enumeration Date | 2006-07-06 |
| Last Update Date | 2019-10-16 |