| NPI | 1790192466 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NY 006238-01) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NY 006238-1) |
| 152WV0400X Optometrist, Vision Therapy (Licence: NY 006238-1) | |
| Enumeration Date | 2014-07-15 |
| Last Update Date | 2016-11-18 |