| NPI | 1174660757 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NJ 5464) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NJ 27OA00546400) |
| Enumeration Date | 2007-01-31 |
| Last Update Date | 2024-03-18 |