| NPI | 1285741454 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NJ TO00919) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NJ OA005489) |
| 152W00000X Optometrist (Licence: PA OEG000338) | |
| Enumeration Date | 2006-08-24 |
| Last Update Date | 2007-07-08 |