| NPI | 1083095582 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152WL0500X Optometrist, Low Vision Rehabilitation (Licence: NY 008281) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NJ 27OA00665100) |
| Enumeration Date | 2015-06-11 |
| Last Update Date | 2016-11-02 |