| NPI | 1518746247 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NJ 27OA00724100) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NJ 27OM00191500) |
| Enumeration Date | 2023-09-22 |
| Last Update Date | 2023-09-22 |