| NPI | 1659323418 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NJ 27OM00044200) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NY TUV004434-1) |
| Enumeration Date | 2006-05-17 |
| Last Update Date | 2010-08-23 |