| NPI | 1487935151 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NC 2232) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NJ 27OA00633600) |
| Enumeration Date | 2011-09-07 |
| Last Update Date | 2018-08-24 |