| NPI | 1427670256 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NJ 27OA00676900) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: OH OPT.006863) |
| Enumeration Date | 2020-05-14 |
| Last Update Date | 2020-07-15 |