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 |