| NPI | 1063462174 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: CT 002193) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: MA 3452) |
| 152W00000X Optometrist (Licence: NH 1034) | |
| Enumeration Date | 2006-05-11 |
| Last Update Date | 2023-11-02 |