| NPI | 1639289804 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NY TUV007396-1) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NJ 27OA00562000) |
| Enumeration Date | 2006-08-30 |
| Last Update Date | 2022-09-21 |