| NPI | 1932615788 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NY c5885) |
| Additional Taxonomies | 247200000X Technician, Other (Licence: NY 5885) |
| Enumeration Date | 2017-12-15 |
| Last Update Date | 2017-12-15 |