| NPI | 1477532661 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NJ OA587100) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NJ TO126400) |
| 152W00000X Optometrist (Licence: NJ OM0012300) | |
| Enumeration Date | 2006-01-16 |
| Last Update Date | 2014-02-01 |