| NPI | 1790997419 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NY 007485) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: AK 210) |
| 152WP0200X Optometrist, Pediatrics (Licence: NY 007485) | |
| 152WC0802X Optometrist, Corneal and Contact Management (Licence: NY 007485) | |
| Enumeration Date | 2007-05-04 |
| Last Update Date | 2010-03-03 |