| NPI | 1952409187 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NY TUV-0003683) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NY TUV003683) |
| Enumeration Date | 2006-09-20 |
| Last Update Date | 2023-07-13 |