| NPI | 1891826533 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NJ 27OA00276900) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NJ 27TO00045300) |
| Enumeration Date | 2007-03-07 |
| Last Update Date | 2009-04-15 |