| NPI | 1649499856 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: SC 1555) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NJ 27OA00403600) |
| Enumeration Date | 2007-04-25 |
| Last Update Date | 2014-05-01 |