| NPI | 1851709091 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: CO OPT.0003115) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NJ 27OA00655100) |
| Enumeration Date | 2014-07-31 |
| Last Update Date | 2016-08-17 |