| NPI | 1396707584 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NY TUV004752-1) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NJ 27OAOO472300) |
| Enumeration Date | 2006-04-04 |
| Last Update Date | 2007-07-08 |