| NPI | 1881785707 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NJ TO-000480) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NJ OA-4768) |
| Enumeration Date | 2006-09-27 |
| Last Update Date | 2007-07-08 |