| NPI | 1124107685 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NY TUV004314-01) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NJ 27OA00452600) |
| 152W00000X Optometrist (Licence: MA OPT3130) | |
| 152W00000X Optometrist (Licence: CT 2012) | |
| 152WC0802X Optometrist, Corneal and Contact Management (Licence: NY TUV004314-01) | |
| 152WX0102X Optometrist, Occupational Vision (Licence: NY TUV004314-01) | |
| Enumeration Date | 2006-11-03 |
| Last Update Date | 2023-02-17 |