| NPI | 1770857203 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NJ 27OA00652200) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: CA 14314) |
| Enumeration Date | 2012-03-01 |
| Last Update Date | 2023-01-25 |