NPI | 1043222953 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 152W00000X Optometrist (Licence: NJ 27OA00350500) |
Additional Taxonomies | 152W00000X Optometrist (Licence: NJ 27TO00036100) |
Enumeration Date | 2006-08-12 |
Last Update Date | 2007-11-07 |