| NPI | 1083094635 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NJ 27OA00669100) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NJ 27OM00136800) |
| 152W00000X Optometrist (Licence: NY TUV008161-1) | |
| Enumeration Date | 2015-06-08 |
| Last Update Date | 2022-10-19 |