| NPI | 1487623112 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NY TUV005619) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NJ 270A00534900) |
| Enumeration Date | 2006-03-15 |
| Last Update Date | 2008-07-08 |