| NPI | 1093093734 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NJ 27OA00632700) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NY TUV007732) |
| Enumeration Date | 2011-07-29 |
| Last Update Date | 2011-07-29 |