| NPI | 1023586179 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NJ 27OA00684500) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NY 008908) |
| Enumeration Date | 2018-11-07 |
| Last Update Date | 2019-02-08 |