| NPI | 1710985866 | 
|---|---|
| Entity Type | Individual | 
| Gender | Male | 
| Sole Proprietor ? | No | 
| Primary Taxonomy | 152W00000X Optometrist (Licence: NH 0799G) | 
| Additional Taxonomies | 152W00000X Optometrist (Licence: NJ 27OA03548) | 
| Enumeration Date | 2005-07-12 | 
| Last Update Date | 2010-01-19 |