| NPI | 1619905155 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NJ 27OA00364700) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NJ 27OA00364701) |
| 152W00000X Optometrist (Licence: NJ 27OA00364702) | |
| 152W00000X Optometrist (Licence: NY T3456-1) | |
| 152W00000X Optometrist (Licence: PA OE5197-T) | |
| Enumeration Date | 2006-06-30 |
| Last Update Date | 2007-10-11 |