| NPI | 1275391161 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NJ 27OA00727100) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NY ORT009940-01) |
| 152W00000X Optometrist (Licence: NJ 27OA00727101) | |
| Enumeration Date | 2024-03-06 |
| Last Update Date | 2025-08-09 |