| NPI | 1518537331 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NY TUV009360) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NJ 27OA00706100) |
| 152W00000X Optometrist (Licence: NJ 27M00173300) | |
| 152W00000X Optometrist (Licence: NY 009360) | |
| Enumeration Date | 2021-06-25 |
| Last Update Date | 2021-06-25 |