| NPI | 1407848724 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NY TUV003680) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NY TU003680-1) |
| 152WL0500X Optometrist, Low Vision Rehabilitation (Licence: NY TU003680-1) | |
| Enumeration Date | 2005-08-23 |
| Last Update Date | 2016-04-14 |