| NPI | 1528012333 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: CT 002905) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NY 005575) |
| 152WC0802X Optometrist, Corneal and Contact Management (Licence: NY VUT5575) | |
| Enumeration Date | 2006-05-19 |
| Last Update Date | 2023-05-05 |