| NPI | 1205119120 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NY TUV007822) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: FL OPC4642) |
| 152WC0802X Optometrist, Corneal and Contact Management (Licence: NY TUV007822) | |
| 152WV0400X Optometrist, Vision Therapy (Licence: NY TUV007822) | |
| 152WS0006X Optometrist, Sports Vision (Licence: NY TUV007822) | |
| 152WP0200X Optometrist, Pediatrics (Licence: NY TUV007822) | |
| Enumeration Date | 2011-09-27 |
| Last Update Date | 2013-05-22 |