| NPI | 1861086910 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NY 009308-01) |
| Additional Taxonomies | 207W00000X Ophthalmology (Licence: NY 009308-01) |
| Enumeration Date | 2021-03-01 |
| Last Update Date | 2021-03-04 |