| NPI | 1184668121 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152WC0802X Optometrist, Corneal and Contact Management (Licence: NY TUV006632) |
| Additional Taxonomies | 152WL0500X Optometrist, Low Vision Rehabilitation (Licence: NY TUV006632) |
| 152WV0400X Optometrist, Vision Therapy (Licence: NY TUV 006632) | |
| 152WP0200X Optometrist, Pediatrics (Licence: NY TUV 006632) | |
| 152W00000X Optometrist (Licence: NY TUV 006632) | |
| Enumeration Date | 2006-06-16 |
| Last Update Date | 2010-05-26 |