| NPI | 1225559651 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NJ 27OA00684700) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NY 8657) |
| Enumeration Date | 2017-07-07 |
| Last Update Date | 2022-06-09 |