| NPI | 1396724001 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NJ 27OA00565200) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NY TUV6107-1) |
| Enumeration Date | 2006-01-11 |
| Last Update Date | 2024-01-08 |