| NPI | 1306880257 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NJ 27OA00598300) |
| Additional Taxonomies | 152WS0006X Optometrist, Sports Vision (Licence: NJ 27OA00598300) |
| 152WC0802X Optometrist, Corneal and Contact Management (Licence: NJ 27OA00598300) | |
| Enumeration Date | 2006-06-15 |
| Last Update Date | 2021-04-21 |