| NPI | 1154427532 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NJ 27OA00607300) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NY vut005869) |
| Enumeration Date | 2006-09-15 |
| Last Update Date | 2008-03-24 |