| NPI | 1457357717 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NJ 27OA00554300) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: PA OEG001612) |
| Enumeration Date | 2005-06-22 |
| Last Update Date | 2010-08-23 |