| NPI | 1962062430 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NJ 27OA00693100) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: PA OEG003556) |
| Enumeration Date | 2019-06-17 |
| Last Update Date | 2021-06-16 |