| NPI | 1902238314 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NJ 27OA00655300) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: FL OPC 4987) |
| Enumeration Date | 2013-08-08 |
| Last Update Date | 2024-05-21 |