| NPI | 1346365020 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NJ 27OA00549400) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NY 005860) |
| Enumeration Date | 2007-03-20 |
| Last Update Date | 2019-11-15 |