| NPI | 1457393969 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: VA 0618003170) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NJ 27OA00425900) |
| 152WC0802X Optometrist, Corneal and Contact Management (Licence: NJ 27OA00425900) | |
| Enumeration Date | 2006-06-11 |
| Last Update Date | 2022-09-07 |