| NPI | 1346356185 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NJ 27OA006059000) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NY 007067) |
| Enumeration Date | 2006-08-22 |
| Last Update Date | 2026-04-17 |