| NPI | 1962701763 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NY 007670) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NY 5600760) |
| Enumeration Date | 2011-03-18 |
| Last Update Date | 2023-07-03 |