| NPI | 1013977685 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: MA 4028) |
| Additional Taxonomies | 152WL0500X Optometrist, Low Vision Rehabilitation (Licence: MA 4028) |
| 152WC0802X Optometrist, Corneal and Contact Management (Licence: MA 4028) | |
| Enumeration Date | 2006-03-27 |
| Last Update Date | 2014-06-18 |