| NPI | 1487038576 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NJ 27OA00661900) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NY TUV008308) |
| Enumeration Date | 2015-07-17 |
| Last Update Date | 2022-08-02 |