| NPI | 1235547209 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 152W00000X Optometrist (Licence: NJ 27OA00659901) | 
| Additional Taxonomies | 152W00000X Optometrist (Licence: NJ 27OA00659900) | 
| Enumeration Date | 2014-07-23 | 
| Last Update Date | 2024-11-27 |