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 |