| NPI | 1174551576 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152WP0200X Optometrist, Pediatrics (Licence: NJ 27OA00505200) |
| Additional Taxonomies | 152WC0802X Optometrist, Corneal and Contact Management (Licence: NJ 270A00505200) |
| 152WX0102X Optometrist, Occupational Vision (Licence: NJ NJOA00505200) | |
| Enumeration Date | 2006-06-28 |
| Last Update Date | 2012-10-29 |