| NPI | 1881689610 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NJ 27 OA 00289000) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NJ 27 OM 00012400) |
| 152WC0802X Optometrist, Corneal and Contact Management (Licence: NJ 27 OA 00289000) | |
| 152WL0500X Optometrist, Low Vision Rehabilitation (Licence: NJ 27 OA 00289000) | |
| 152WP0200X Optometrist, Pediatrics (Licence: NJ 27 OA 00289000) | |
| Enumeration Date | 2005-09-19 |
| Last Update Date | 2018-11-20 |