| NPI | 1952390536 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: NJ 5021) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: NY 4986) |
| Enumeration Date | 2005-10-17 |
| Last Update Date | 2012-10-03 |