| NPI | 1922186246 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NJ 27OA00529400) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NJ 5294) |
| Enumeration Date | 2006-11-02 |
| Last Update Date | 2022-11-18 |