| NPI | 1467531590 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NC 2613) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NJ 27TO00110700) |
| 152W00000X Optometrist (Licence: OR 3283T) | |
| Enumeration Date | 2006-11-02 |
| Last Update Date | 2020-05-15 |