| NPI | 1588735021 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NJ 27OA00401600) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NJ 27OM00087400) |
| Enumeration Date | 2006-11-13 |
| Last Update Date | 2016-11-17 |