| NPI | 1184781213 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152WL0500X Optometrist, Low Vision Rehabilitation (Licence: NJ 27OA00416900) |
| Additional Taxonomies | 152WP0200X Optometrist, Pediatrics (Licence: NJ 27OA00416900) |
| 152WV0400X Optometrist, Vision Therapy (Licence: NJ 27OA00416900) | |
| Enumeration Date | 2007-01-01 |
| Last Update Date | 2013-04-03 |