| NPI | 1205010675 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NY TOO2143-1) |
| Additional Taxonomies | 152WC0802X Optometrist, Corneal and Contact Management (Licence: NY TOO2143-1) |
| Enumeration Date | 2007-12-20 |
| Last Update Date | 2023-09-07 |