| NPI | 1609124296 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NJ 27OA00641300) |
| Additional Taxonomies | 152WV0400X Optometrist, Vision Therapy (Licence: NJ 27OA00641300) |
| Enumeration Date | 2012-08-29 |
| Last Update Date | 2018-01-03 |