| NPI | 1396718920 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NJ 27OA003407) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: GA OPT001628) |
| 152WC0802X Optometrist, Corneal and Contact Management (Licence: NJ 27OM00015200) | |
| Enumeration Date | 2006-02-13 |
| Last Update Date | 2011-01-19 |