| NPI | 1205817517 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NJ 27OA00403900) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NJ 27TO00057400) |
| Enumeration Date | 2005-11-14 |
| Last Update Date | 2007-07-08 |