| NPI | 1972976819 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: MD TA2504) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NJ 27OA00664200) |
| 152W00000X Optometrist (Licence: NY TUV008377-1) | |
| Enumeration Date | 2015-10-31 |
| Last Update Date | 2023-06-30 |