| NPI | 1093121782 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NJ 270A00673500) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: PA OEG003858) |
| 152W00000X Optometrist (Licence: NJ 27OA00673500) | |
| Enumeration Date | 2014-07-02 |
| Last Update Date | 2022-05-10 |