| NPI | 1407838451 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: NY 150650) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NY 150650) |
| Enumeration Date | 2005-11-16 |
| Last Update Date | 2018-11-27 |