| NPI | 1356409288 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NJ 27OA00355500) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NJ 27TO00074400) |
| Enumeration Date | 2006-12-04 |
| Last Update Date | 2007-07-08 |