| NPI | 1922210947 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NJ 27OA00411000) |
| Additional Taxonomies | 152WC0802X Optometrist, Corneal and Contact Management (Licence: NJ 27TO00020200) |
| Enumeration Date | 2007-05-03 |
| Last Update Date | 2008-08-04 |