| NPI | 1790707271 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NY TUV005757) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NJ OA00601700) |
| Enumeration Date | 2006-07-24 |
| Last Update Date | 2018-04-30 |