| NPI | 1861435638 |
|---|---|
| Entity Type | Individual |
| Gender | N/A |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NJ OA5203) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NJ 27OA00520300) |
| Enumeration Date | 2006-06-13 |
| Last Update Date | 2016-07-26 |