| NPI | 1861444762 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 156FX1800X Technician/Technologist, Optician (Licence: NY 4019) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NY 5907) |
| Enumeration Date | 2006-05-17 |
| Last Update Date | 2010-05-04 |