| NPI | 1407303621 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NJ 27OA00669600) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NY 008519) |
| Enumeration Date | 2016-09-06 |
| Last Update Date | 2017-03-19 |