| NPI | 1578566485 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NY 3794) |
| Additional Taxonomies | 152WL0500X Optometrist, Low Vision Rehabilitation (Licence: NY 3794) |
| 152WP0200X Optometrist, Pediatrics (Licence: NY 3794) | |
| 152WV0400X Optometrist, Vision Therapy (Licence: NY 3794) | |
| Enumeration Date | 2005-05-24 |
| Last Update Date | 2023-02-15 |