| NPI | 1598140931 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NY TUV00818188-1) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NJ 27OM00123500) |
| Enumeration Date | 2015-07-28 |
| Last Update Date | 2016-10-20 |