| NPI | 1437170016 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NJ 27OA00589300) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NY TUV-006709) |
| Enumeration Date | 2006-07-21 |
| Last Update Date | 2022-07-21 |