| NPI | 1164464962 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 207R00000X Internal Medicine (Licence: NJ 25MA08733200) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NY T006103) |
| 207R00000X Internal Medicine (Licence: PA MD440545) | |
| 152W00000X Optometrist (Licence: NJ OA05663) | |
| Enumeration Date | 2006-06-13 |
| Last Update Date | 2011-01-04 |