| NPI | 1568437671 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NJ OA04226) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NJ TO000371) |
| Enumeration Date | 2006-02-22 |
| Last Update Date | 2013-08-16 |