| NPI | 1487631024 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NY VUT005307) |
| Additional Taxonomies | 152WC0802X Optometrist, Corneal and Contact Management (Licence: NY VUT005307) |
| 152WP0200X Optometrist, Pediatrics (Licence: NY VUT005307) | |
| 152WS0006X Optometrist, Sports Vision (Licence: NY VUT005307) | |
| 152WX0102X Optometrist, Occupational Vision (Licence: NY V) | |
| Enumeration Date | 2005-12-25 |
| Last Update Date | 2007-07-08 |