| NPI | 1629576186 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NJ 27OA00678300) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: FL 5829) |
| Enumeration Date | 2018-01-30 |
| Last Update Date | 2021-09-13 |