| NPI | 1578568333 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152WV0400X Optometrist, Vision Therapy (Licence: NY 2714) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NY 2714) |
| 152W00000X Optometrist (Licence: TN od0000002353) | |
| Enumeration Date | 2005-06-17 |
| Last Update Date | 2010-09-03 |