| NPI | 1255542254 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152WC0802X Optometrist, Corneal and Contact Management (Licence: NY TUV006770) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NJ 27OA00593900) |
| 152W00000X Optometrist (Licence: NJ 27TO001322300) | |
| Enumeration Date | 2007-05-24 |
| Last Update Date | 2012-11-16 |