NPI | 1518488394 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 152W00000X Optometrist (Licence: NJ 27OA00710400) |
Additional Taxonomies | 152W00000X Optometrist (Licence: NY TUV008605) |
Enumeration Date | 2017-06-30 |
Last Update Date | 2022-04-07 |