| 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 |