| NPI | 1881165611 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 156FX1800X Technician/Technologist, Optician (Licence: NY 010439-01) |
| Additional Taxonomies | 156FX1202X Technician/Technologist, Optometric Technician |
| Enumeration Date | 2018-12-05 |
| Last Update Date | 2023-05-20 |