| NPI | 1396237335 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NJ 27OM00156000) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NJ 27OA00688000) |
| 152W00000X Optometrist (Licence: UT 10851315-9934) | |
| Enumeration Date | 2018-06-05 |
| Last Update Date | 2022-05-09 |