| NPI | 1891137212 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NY TUV008022) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NY 008022) |
| Enumeration Date | 2013-07-26 |
| Last Update Date | 2019-03-14 |