| NPI | 1649627027 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: CT 2994) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NJ 27OA00673100) |
| Enumeration Date | 2016-05-16 |
| Last Update Date | 2021-03-22 |