| NPI | 1255834768 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NY ORT009058) |
| Additional Taxonomies | 152WC0802X Optometrist Corneal and Contact Management (Licence: NY ORT009058) |
| 152WP0200X Optometrist Pediatrics (Licence: NY ORT009058) | |
| 152WS0006X Optometrist Sports Vision (Licence: NY ORT009058) | |
| 152WV0400X Optometrist Vision Therapy (Licence: NY ORT009058) | |
| Enumeration Date | 2018-03-10 |
| Last Update Date | 2024-06-07 |