| NPI | 1538161740 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152WC0802X Optometrist, Corneal and Contact Management (Licence: NY TUV4463-1) |
| Additional Taxonomies | 152WC0802X Optometrist, Corneal and Contact Management (Licence: NJ 27OA004485) |
| Enumeration Date | 2005-06-01 |
| Last Update Date | 2010-12-16 |