| NPI | 1376698845 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NJ 27OA00417500) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NJ 4175) |
| Enumeration Date | 2007-01-24 |
| Last Update Date | 2014-05-15 |