| NPI | 1104991660 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152WS0006X Optometrist, Sports Vision (Licence: NY T004397-1) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NY 4397) |
| 152W00000X Optometrist (Licence: NY T004397-1) | |
| 152WC0802X Optometrist, Corneal and Contact Management (Licence: NY T004397-1) | |
| 152WV0400X Optometrist, Vision Therapy (Licence: NY T004397-1) | |
| Enumeration Date | 2006-11-21 |
| Last Update Date | 2023-07-06 |