| NPI | 1881698322 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NY T005484-1) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NJ 27OA00603100) |
| Enumeration Date | 2005-06-13 |
| Last Update Date | 2025-02-25 |