| NPI | 1891791018 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NY vut4679) |
| Additional Taxonomies | 146N00000X Emergency Medical Technician, Basic (Licence: NY 320607) |
| Enumeration Date | 2005-06-22 |
| Last Update Date | 2009-12-15 |