| NPI | 1275625139 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NJ 27OA00359100) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: PA OE005047P) |
| Enumeration Date | 2006-09-29 |
| Last Update Date | 2012-10-19 |