| NPI | 1568409753 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NJ 27TO00054600) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NJ 27OA00462500) |
| Enumeration Date | 2006-05-31 |
| Last Update Date | 2011-12-14 |