| NPI | 1376104190 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NJ 27OA00689100) |
| Additional Taxonomies | 152WC0802X Optometrist, Corneal and Contact Management (Licence: NJ 27OA00689100) |
| 152WP0200X Optometrist, Pediatrics (Licence: NJ 27OA00689100) | |
| Enumeration Date | 2019-06-24 |
| Last Update Date | 2026-05-07 |