| NPI | 1073737193 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: MA OP-3832-TP) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: MA 3832-TP) |
| Enumeration Date | 2007-04-12 |
| Last Update Date | 2020-03-31 |