| NPI | 1134645310 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 207W00000X Ophthalmology (Licence: NJ 27OA00675700) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NJ 27oa00675700) |
| Enumeration Date | 2017-08-18 |
| Last Update Date | 2022-07-21 |