| NPI | 1083657936 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NJ 27OA00376900) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: PA OE005265P) |
| Enumeration Date | 2006-06-14 |
| Last Update Date | 2011-08-02 |