| NPI | 1447378708 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NJ 27OA00480700) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NY TO4837-1) |
| Enumeration Date | 2007-03-26 |
| Last Update Date | 2007-07-08 |