| NPI | 1750340535 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NJ 27TO00108200) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NJ 27OA00566000) |
| Enumeration Date | 2006-03-21 |
| Last Update Date | 2007-07-08 |