| NPI | 1801977889 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NJ 27OA00437700) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NJ 27OM00075900) |
| Enumeration Date | 2006-10-18 |
| Last Update Date | 2014-07-18 |