| 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 |