| NPI | 1760738074 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NY TUV007827) |
| Additional Taxonomies | 152WP0200X Optometrist, Pediatrics (Licence: NY TUV007827) |
| 207WX0110X Ophthalmology, Pediatric Ophthalmology and Strabismus Specialist (Licence: NY TUV007827) | |
| Enumeration Date | 2012-07-24 |
| Last Update Date | 2021-01-09 |