| NPI | 1912094764 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NJ OA5680) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NJ TO1083) |
| 152W00000X Optometrist (Licence: NV 925) | |
| Enumeration Date | 2006-10-05 |
| Last Update Date | 2018-03-30 |