NPI | 1376567198 |
---|---|
Entity Type | Individual |
Gender | Male |
Sole Proprietor ? | Yes |
Primary Taxonomy | 152W00000X Optometrist (Licence: NJ TO00018500) |
Additional Taxonomies | 152W00000X Optometrist (Licence: NJ OA00397000) |
Enumeration Date | 2006-07-26 |
Last Update Date | 2012-01-10 |