NPI | 1306880257 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 152W00000X Optometrist (Licence: NJ 27OA00598300) |
Additional Taxonomies | 152WS0006X Optometrist, Sports Vision (Licence: NJ 27OA00598300) |
152WC0802X Optometrist, Corneal and Contact Management (Licence: NJ 27OA00598300) | |
Enumeration Date | 2006-06-15 |
Last Update Date | 2021-04-21 |