| NPI | 1003876723 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NY TUV002123-1) |
| Additional Taxonomies | 152WL0500X Optometrist, Low Vision Rehabilitation (Licence: NY TUV002123-1) |
| 152WP0200X Optometrist, Pediatrics (Licence: NY TUV002123-1) | |
| 152WX0102X Optometrist, Occupational Vision (Licence: NY TUV002123-1) | |
| Enumeration Date | 2006-03-25 |
| Last Update Date | 2010-11-03 |