| NPI | 1215987888 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152WX0102X Optometrist, Occupational Vision (Licence: NJ 27OA000470600) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NY TUV004989) |
| Enumeration Date | 2006-05-12 |
| Last Update Date | 2019-04-19 |