| NPI | 1568441459 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NY T005807) |
| Additional Taxonomies | 152WC0802X Optometrist Corneal and Contact Management (Licence: NY T005807) |
| Enumeration Date | 2006-01-10 |
| Last Update Date | 2021-06-03 |