| NPI | 1942651666 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NJ 27OA00670400) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: PA OEG003176) |
| Enumeration Date | 2016-06-23 |
| Last Update Date | 2024-05-13 |