| NPI | 1003548538 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NJ 27OA00713400) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NJ 27OM0017990) |
| Enumeration Date | 2022-06-24 |
| Last Update Date | 2022-06-24 |