| NPI | 1477781763 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NJ 27OA00619200) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NY TUV007432-1) |
| Enumeration Date | 2009-06-25 |
| Last Update Date | 2012-06-13 |