| NPI | 1538575758 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NJ 27OA00656200) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NY TUV008202-1) |
| Enumeration Date | 2014-07-08 |
| Last Update Date | 2023-01-11 |