NPI | 1093934465 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 152W00000X Optometrist (Licence: NJ 27OA005529) |
Additional Taxonomies | 152W00000X Optometrist (Licence: NY VUT005719) |
Enumeration Date | 2007-04-24 |
Last Update Date | 2007-07-08 |