| NPI | 1760423321 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NY TUVOO4881-1) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NY TUV004881) |
| 152WC0802X Optometrist, Corneal and Contact Management (Licence: NY TUV004881) | |
| 152WL0500X Optometrist, Low Vision Rehabilitation (Licence: NY TUV004881) | |
| 152WP0200X Optometrist, Pediatrics (Licence: NY TUV004881) | |
| 152WX0102X Optometrist, Occupational Vision (Licence: NY TUV004881) | |
| Enumeration Date | 2006-06-08 |
| Last Update Date | 2023-07-07 |