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 |