| NPI | 1710429089 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NJ 27OA00678900) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: IL 046.011073) |
| 152W00000X Optometrist (Licence: NY 008743) | |
| Enumeration Date | 2016-11-17 |
| Last Update Date | 2020-06-25 |