| NPI | 1851398630 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NY VUT005025-1) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NY 5025) |
| Enumeration Date | 2005-07-07 |
| Last Update Date | 2023-07-05 |