| NPI | 1518221696 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NY TUV007874-1) |
| Additional Taxonomies | 152WV0400X Optometrist, Vision Therapy (Licence: NY TUV007874-1) |
| Enumeration Date | 2012-07-03 |
| Last Update Date | 2012-07-03 |