| NPI | 1003904988 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NY 3873) |
| Additional Taxonomies | 152WV0400X Optometrist Vision Therapy (Licence: NY 3873) |
| Enumeration Date | 2006-10-10 |
| Last Update Date | 2007-07-08 |