NPI | 1346356185 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 152W00000X Optometrist (Licence: NJ 27OA006059000) |
Additional Taxonomies | 152W00000X Optometrist (Licence: NY 007067) |
Enumeration Date | 2006-08-22 |
Last Update Date | 2011-12-29 |