| NPI | 1730660846 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NJ 270A00726200) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: SC OPT.2222) |
| Enumeration Date | 2018-08-27 |
| Last Update Date | 2024-12-03 |