| NPI | 1215936877 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NY VUT005707-1) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NY TUV005707-1) |
| 152WC0802X Optometrist, Corneal and Contact Management (Licence: NY VUT005707-1) | |
| 152WC0802X Optometrist, Corneal and Contact Management (Licence: NY TUV005707) | |
| Enumeration Date | 2005-07-17 |
| Last Update Date | 2008-10-20 |