| NPI | 1144380478 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 152W00000X Optometrist (Licence: ME OPT948) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: UT 6256310-9934) |
| Enumeration Date | 2006-12-08 |
| Last Update Date | 2014-07-16 |