| NPI | 1144291931 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NJ 270A00349600) |
| Additional Taxonomies | 152WV0400X Optometrist, Vision Therapy (Licence: NJ 27T000072100) |
| Enumeration Date | 2006-01-30 |
| Last Update Date | 2008-04-04 |