| NPI | 1487798864 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NY TUV002781-1) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NJ 278400) |
| Enumeration Date | 2007-02-17 |
| Last Update Date | 2011-12-21 |