| NPI | 1073239059 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NY 009749) |
| Additional Taxonomies | 152WV0400X Optometrist, Vision Therapy (Licence: NJ 27OA00717300) |
| Enumeration Date | 2022-10-12 |
| Last Update Date | 2024-05-30 |