| NPI | 1619074200 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NY TUV006253-1) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NJ 27OA00578000) |
| 152W00000X Optometrist (Licence: NJ 27TO00123200) | |
| Enumeration Date | 2006-09-17 |
| Last Update Date | 2016-05-14 |