| NPI | 1730220211 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NJ 27OA00431000) |
| Additional Taxonomies | 152WV0400X Optometrist Vision Therapy (Licence: NY 4203) |
| Enumeration Date | 2007-02-09 |
| Last Update Date | 2007-09-20 |