| NPI | 1013400043 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NJ 27OA00680100) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NY 008785) |
| 152WC0802X Optometrist, Corneal and Contact Management (Licence: NJ 27OA00680100) | |
| Enumeration Date | 2018-06-13 |
| Last Update Date | 2024-05-21 |