| NPI | 1649278839 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NJ 27TO00049400) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NJ 27OA00396800) |
| Enumeration Date | 2005-07-12 |
| Last Update Date | 2012-09-19 |