| NPI | 1124510870 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NJ 27OA00680800) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: PA Pending) |
| Enumeration Date | 2018-05-30 |
| Last Update Date | 2024-09-10 |