| NPI | 1497312011 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NJ 27OA00689300) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NY 008986) |
| Enumeration Date | 2019-05-20 |
| Last Update Date | 2019-07-02 |