| NPI | 1457460149 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: CT 002631) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NJ 27OA00590200) |
| Enumeration Date | 2006-08-29 |
| Last Update Date | 2013-02-27 |