| NPI | 1043212087 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: MA 3863) |
| Additional Taxonomies | 152WL0500X Optometrist, Low Vision Rehabilitation (Licence: MA 3863) |
| 152WC0802X Optometrist, Corneal and Contact Management (Licence: MA 3863) | |
| Enumeration Date | 2005-08-10 |
| Last Update Date | 2012-09-19 |