| NPI | 1104101492 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NJ 270OA00635500) |
| Additional Taxonomies | 152WC0802X Optometrist, Corneal and Contact Management (Licence: NJ 27OA00635500) |
| 152WL0500X Optometrist, Low Vision Rehabilitation (Licence: NJ 27OA635500) | |
| 152WV0400X Optometrist, Vision Therapy (Licence: NJ 27OA00635500) | |
| Enumeration Date | 2011-10-18 |
| Last Update Date | 2011-10-18 |