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 |