| NPI | 1013552421 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NY TUV009055-01) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NJ 27OA00692900) |
| 152W00000X Optometrist (Licence: NJ 27OM00160500) | |
| Enumeration Date | 2019-11-08 |
| Last Update Date | 2019-11-08 |