| NPI | 1528076478 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NJ 27OA00591300) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: PA OEG001163) |
| Enumeration Date | 2006-08-04 |
| Last Update Date | 2021-04-12 |