| NPI | 1487791166 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NJ 27oa00506400) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NJ to00492) |
| Enumeration Date | 2007-01-31 |
| Last Update Date | 2007-07-09 |