| NPI | 1083771109 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 156FX1800X Technician/Technologist, Optician (Licence: NJ 31TD00083700) |
| Additional Taxonomies | 156FX1800X Technician/Technologist, Optician (Licence: NY 00003468) |
| Enumeration Date | 2007-01-02 |
| Last Update Date | 2007-07-08 |