| NPI | 1811924095 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NJ 27OA00384500) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NJ 27TO00046000) |
| Enumeration Date | 2006-06-26 |
| Last Update Date | 2012-05-19 |