| NPI | 1326125030 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NJ 27OA00547200) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NY TUV005833-1) |
| Enumeration Date | 2006-11-01 |
| Last Update Date | 2008-08-25 |