| NPI | 1821471590 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NJ 27OA00660300) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NJ 27OM00128000) |
| Enumeration Date | 2015-06-30 |
| Last Update Date | 2019-10-20 |