| NPI | 1760653331 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NJ 27OA00605500) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NY T-006457) |
| Enumeration Date | 2008-03-21 |
| Last Update Date | 2014-09-07 |