| 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 |