| NPI | 1649337809 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NJ 27OA00600601) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NJ 27TO00139201) |
| Enumeration Date | 2007-01-03 |
| Last Update Date | 2023-05-17 |