| NPI | 1710769872 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NY 009789) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NJ 27OM00204000) |
| 152W00000X Optometrist (Licence: NJ 27OA00736100) | |
| Enumeration Date | 2023-10-13 |
| Last Update Date | 2026-01-08 |