| NPI | 1407949621 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207Q00000X Family Medicine (Licence: NY 277295) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: FL OPC3141) |
| 152W00000X Optometrist (Licence: NY T005983) | |
| 152W00000X Optometrist (Licence: PA OE8142) | |
| 207QA0401X Family Medicine, Addiction Medicine (Licence: NY 277295) | |
| Enumeration Date | 2006-10-02 |
| Last Update Date | 2022-04-11 |