| NPI | 1578932463 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NJ 27OA00663500) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NY 56 008337) |
| Enumeration Date | 2015-09-21 |
| Last Update Date | 2023-02-05 |