| NPI | 1871996504 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 156FX1100X Technician/Technologist, Ophthalmic (Licence: NY 55007837) |
| Additional Taxonomies | 156FX1800X Technician/Technologist, Optician (Licence: NY 55007837) |
| Enumeration Date | 2014-10-08 |
| Last Update Date | 2014-10-08 |