| NPI | 1689640252 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NJ 27OA00275200) |
| Additional Taxonomies | 152WL0500X Optometrist, Low Vision Rehabilitation (Licence: NJ 27OA00275200) |
| 152WV0400X Optometrist, Vision Therapy (Licence: NJ 27OA00275200) | |
| Enumeration Date | 2006-02-24 |
| Last Update Date | 2011-01-06 |