| NPI | 1366550410 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152WV0400X Optometrist, Vision Therapy (Licence: NY 005227) |
| Additional Taxonomies | 152WL0500X Optometrist, Low Vision Rehabilitation (Licence: NY 005227) |
| 152WP0200X Optometrist, Pediatrics (Licence: NY 005227) | |
| 152WS0006X Optometrist, Sports Vision (Licence: NY 005227) | |
| Enumeration Date | 2006-08-28 |
| Last Update Date | 2018-07-25 |