| NPI | 1649275405 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NJ 270A00393600) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NJ 27TO00039500) |
| Enumeration Date | 2005-06-17 |
| Last Update Date | 2009-10-20 |