| NPI | 1225076425 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NJ to000189) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NJ oa2888) |
| Enumeration Date | 2006-06-02 |
| Last Update Date | 2007-07-08 |