| NPI | 1881379568 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NJ 27OA00727200) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NY 009900) |
| Enumeration Date | 2023-06-20 |
| Last Update Date | 2024-10-22 |