| NPI | 1437361359 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NY T005214) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NJ 27OA00553500) |
| Enumeration Date | 2007-05-04 |
| Last Update Date | 2007-07-08 |