| NPI | 1295733095 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NJ 27OA00374800) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NY TUV003432-1) |
| 152W00000X Optometrist (Licence: NJ 27OM00013300) | |
| 152W00000X Optometrist (Licence: NJ CDS#D09092900) | |
| Enumeration Date | 2005-07-14 |
| Last Update Date | 2012-10-15 |