| NPI | 1780727800 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NJ TPA TO00084100) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: PA OEG001553) |
| 152W00000X Optometrist (Licence: MA 3807) | |
| 152W00000X Optometrist (Licence: FL OPC 2834 12101) | |
| Enumeration Date | 2007-02-15 |
| Last Update Date | 2007-07-08 |