| NPI | 1801980461 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NJ 27OA00466700) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: PA OE006546P) |
| 152WC0802X Optometrist, Corneal and Contact Management (Licence: NJ 27OA00466700) | |
| 152WC0802X Optometrist, Corneal and Contact Management (Licence: PA OE006546P) | |
| 152WP0200X Optometrist, Pediatrics (Licence: NJ 27OA00466700) | |
| 152WP0200X Optometrist, Pediatrics (Licence: PA OE006546P) | |
| 152WX0102X Optometrist, Occupational Vision (Licence: NJ 27OA00466700) | |
| 152WX0102X Optometrist, Occupational Vision (Licence: PA OE006546P) | |
| Enumeration Date | 2006-10-03 |
| Last Update Date | 2010-07-12 |