| NPI | 1902990021 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 156FX1100X Technician/Technologist, Ophthalmic (Licence: NY 2962) |
| Additional Taxonomies | 156FC0801X Technician/Technologist, Contact Lens Fitter (Licence: NY 2962) |
| Enumeration Date | 2006-10-03 |
| Last Update Date | 2008-07-22 |