| NPI | 1932166170 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NJ 27OA00523300) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: MA 3739) |
| 152W00000X Optometrist (Licence: NJ 27OM00041200) | |
| Enumeration Date | 2006-05-01 |
| Last Update Date | 2014-05-05 |