| 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 |