| NPI | 1104829100 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: VT 030-0000228) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: VT 228) |
| Enumeration Date | 2005-05-23 |
| Last Update Date | 2016-02-23 |