| NPI | 1457542375 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NY TUV007143-1) |
| Additional Taxonomies | 152WC0802X Optometrist, Corneal and Contact Management (Licence: NY TUV007143-1) |
| Enumeration Date | 2007-08-06 |
| Last Update Date | 2019-05-17 |