| NPI | 1558452516 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NY TUY005152-1) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NY VUT005152-1) |
| 152WC0802X Optometrist, Corneal and Contact Management (Licence: NY TUY005152) | |
| Enumeration Date | 2006-09-27 |
| Last Update Date | 2014-01-13 |