| NPI | 1164494464 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NY TUV006815) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: FL opc3879) |
| 152WL0500X Optometrist, Low Vision Rehabilitation (Licence: FL opc3879) | |
| Enumeration Date | 2006-02-02 |
| Last Update Date | 2010-12-06 |