| NPI | 1053310235 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NJ 27OA00608600) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NY V005967) |
| 152W00000X Optometrist (Licence: NC 1727) | |
| 152W00000X Optometrist (Licence: FL 3861) | |
| Enumeration Date | 2005-07-19 |
| Last Update Date | 2008-03-04 |