| NPI | 1073545059 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152WV0400X Optometrist Vision Therapy (Licence: NY VUT003212) |
| Additional Taxonomies | 152WL0500X Optometrist Low Vision Rehabilitation (Licence: NY VUT003212) |
| Enumeration Date | 2006-07-07 |
| Last Update Date | 2010-10-06 |