| NPI | 1396727426 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NJ 270A00573700) |
| Additional Taxonomies | 152WV0400X Optometrist, Vision Therapy (Licence: NJ 27T000123400) |
| Enumeration Date | 2005-11-15 |
| Last Update Date | 2007-07-08 |