| NPI | 1396981296 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NJ OA4865) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NJ TO00017) |
| Enumeration Date | 2008-12-23 |
| Last Update Date | 2008-12-23 |