| NPI | 1508415126 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NJ 27OM00170200) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: PA OEG003579) |
| Enumeration Date | 2019-09-06 |
| Last Update Date | 2024-06-06 |