NPI | 1184767477 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | No |
Primary Taxonomy | 152W00000X Optometrist (Licence: NJ 27OA00593400) |
Additional Taxonomies | 152W00000X Optometrist (Licence: NY tuv005689) |
152W00000X Optometrist (Licence: PA OE-007865-P) | |
Enumeration Date | 2007-02-15 |
Last Update Date | 2007-07-08 |