| NPI | 1245386549 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NJ OA-004538) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NY TUV-004396) |
| Enumeration Date | 2007-01-27 |
| Last Update Date | 2011-02-22 |